Healthcare Provider Details

I. General information

NPI: 1174762041
Provider Name (Legal Business Name): MARTHA ALICIA GUEVARA M.F.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2009
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GOODRICH BLVD
COMMERCE CA
90022-5103
US

IV. Provider business mailing address

14609 MARYTON AVE
NORWALK CA
90650-5152
US

V. Phone/Fax

Practice location:
  • Phone: 323-832-9795
  • Fax:
Mailing address:
  • Phone: 562-716-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: