Healthcare Provider Details

I. General information

NPI: 1114948908
Provider Name (Legal Business Name): GUADALUPITA ENCINIAS LMSW-CADC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCXK-ADP, BLDG 170 RM 515
FORT IRWIN CA
92310
US

IV. Provider business mailing address

PO BOX 1295
BARSTOW CA
92312-1295
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-4074
  • Fax: 760-380-6469
Mailing address:
  • Phone: 760-380-4032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801069958
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: