Provider Demographics
NPI:1124244777
Name:ROGERS, MARIO LEONE
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:LEONE
Last Name:ROGERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N HARGRAVE ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-5729
Mailing Address - Country:US
Mailing Address - Phone:951-378-0039
Mailing Address - Fax:
Practice Address - Street 1:777 N HARGRAVE ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-5729
Practice Address - Country:US
Practice Address - Phone:951-378-0039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker