Healthcare Provider Details

I. General information

NPI: 1992649974
Provider Name (Legal Business Name): REYMOND LAGUARDIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W EMPIRE AVE # 1054
BURBANK CA
91504-3434
US

IV. Provider business mailing address

2080 W EMPIRE AVE # 1054
BURBANK CA
91504-3434
US

V. Phone/Fax

Practice location:
  • Phone: 818-212-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: