Provider Demographics
NPI:1538751847
Name:MARRERO, ANA GUADALUPE
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:GUADALUPE
Last Name:MARRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14071 PEYTON DR UNIT 744
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-7134
Mailing Address - Country:US
Mailing Address - Phone:909-720-8890
Mailing Address - Fax:
Practice Address - Street 1:500 W 190TH ST FL 4
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4268
Practice Address - Country:US
Practice Address - Phone:951-328-9995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95015992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily