Healthcare Provider Details

I. General information

NPI: 1801463419
Provider Name (Legal Business Name): PATRICIA A MORENO GUADAMUZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BECK AVE # MS 5-120
FAIRFIELD CA
94533-6804
US

IV. Provider business mailing address

275 BECK AVE # MS 5-120
FAIRFIELD CA
94533-6804
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-8059
  • Fax:
Mailing address:
  • Phone: 707-784-8059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19677
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number155565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: