Healthcare Provider Details

I. General information

NPI: 1356521447
Provider Name (Legal Business Name): GUADALUPE T ACOSTA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10428 LOWER AZUSA RD
EL MONTE CA
91731-1208
US

IV. Provider business mailing address

6263 CHURCH ST
LOS ANGELES CA
90042-1421
US

V. Phone/Fax

Practice location:
  • Phone: 626-453-3399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number22857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: