Provider Demographics
NPI:1902620289
Name:GUERENA GONZALEZ, MARIANA
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:GUERENA GONZALEZ
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 1:5900 WESTMINSTER DR UNIT 2317
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2691
Mailing Address - Country:US
Mailing Address - Phone:336-350-4898
Mailing Address - Fax:
Practice Address - Street 1:747 FRONTAGE RD STE B-200
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602
Practice Address - Country:US
Practice Address - Phone:512-920-6512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist