Basic Information
| Provider Information | |||||||||
| NPI: | 1871002766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUERRERO | ||||||||
| FirstName: | SANDRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2116 ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900181353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233349000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2116 ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900181353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233349000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2017 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 101YM0800X | 107549 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.