Healthcare Provider Details

I. General information

NPI: 1962378968
Provider Name (Legal Business Name): IVONNE GUERRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15651 IMPERIAL HWY STE 207
LA MIRADA CA
90638-1653
US

IV. Provider business mailing address

15651 IMPERIAL HWY STE 207
LA MIRADA CA
90638-1653
US

V. Phone/Fax

Practice location:
  • Phone: 562-262-6808
  • Fax:
Mailing address:
  • Phone: 562-262-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23182
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164363
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: