Healthcare Provider Details

I. General information

NPI: 1467932095
Provider Name (Legal Business Name): GUIDING LIGHT CHILDRENS THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9604 ARTESIA BLVD
BELLFLOWER CA
90706-8039
US

IV. Provider business mailing address

13757 PARK ST
CERRITOS CA
90703-1452
US

V. Phone/Fax

Practice location:
  • Phone: 714-251-7252
  • Fax:
Mailing address:
  • Phone: 714-251-7252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MELODIE GATMAITAN LOZENDO
Title or Position: OWNER
Credential:
Phone: 714-251-7252