MEDICARE: MARIA GUADALUPE PARAMO LOAIZA

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	175T00000X	Peer Specialist	MPSS-CREWPD	CA

General Provider Information

NPI Number	:	1689321309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA GUADALUPE PARAMO LOAIZA

Provider Business Mailing Address
First Line	:	5275 MARKET ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-2215
Country	:	US
Telephone Number	:	858-343-4940
Fax Number	:

Provider Business Practice Location Address
First Line	:	5275 MARKET ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-2215
Country	:	US
Telephone Number	:	619-494-7435
Fax Number	:

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

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	08/04/2025

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