MEDICARE: GUADALUPE BUITRON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker		CA
2	1041C0700X	Clinical Social Worker	121510	CA

General Provider Information

NPI Number	:	1043966401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUADALUPE BUITRON

Provider Business Mailing Address
First Line	:	6296 MAGNOLIA AVE # 1061
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2526
Country	:	US
Telephone Number	:	951-241-1132
Fax Number	:

Provider Business Practice Location Address
First Line	:	6296 MAGNOLIA AVE # 1061
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-2526
Country	:	US
Telephone Number	:	951-241-1132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	04/06/2026

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Directions to “ GUADALUPE BUITRON ” Practice Location

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