MEDICARE: ANA KAREN GUADERRAMA LCSW

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	1222562	CA

General Provider Information

NPI Number	:	1164839908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA KAREN GUADERRAMA LCSW

Provider Business Mailing Address
First Line	:	3131 CAMINO DEL RIO N STE 700
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5708
Country	:	US
Telephone Number	:	619-235-0120
Fax Number	:

Provider Business Practice Location Address
First Line	:	3131 CAMINO DEL RIO N STE 700
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5708
Country	:	US
Telephone Number	:	619-235-0120
Fax Number	:

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

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	11/25/2025

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