Provider Demographics
NPI:1184773962
Name:DREISS, CARLOS GUERRA (PHD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:GUERRA
Last Name:DREISS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:IONE
Mailing Address - State:CA
Mailing Address - Zip Code:95640-4504
Mailing Address - Country:US
Mailing Address - Phone:209-207-8500
Mailing Address - Fax:
Practice Address - Street 1:455 EAGLE DR
Practice Address - Street 2:
Practice Address - City:IONE
Practice Address - State:CA
Practice Address - Zip Code:95640-4504
Practice Address - Country:US
Practice Address - Phone:209-207-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19329103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist