Healthcare Provider Details

I. General information

NPI: 1003535634
Provider Name (Legal Business Name): MISS JARELY M GUERRERO SR.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 W BURBANK BLVD STE B
BURBANK CA
91505-2200
US

IV. Provider business mailing address

13225 KELOWNA ST APT 204E
PACOIMA CA
91331-4092
US

V. Phone/Fax

Practice location:
  • Phone: 818-638-9586
  • Fax:
Mailing address:
  • Phone: 818-987-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: