Healthcare Provider Details

I. General information

NPI: 1679379853
Provider Name (Legal Business Name): ILEANA GUERRERO ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2025
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31760 CASINO DR STE 100
LAKE ELSINORE CA
92530-4561
US

IV. Provider business mailing address

31760 CASINO DR STE 100
LAKE ELSINORE CA
92530-4561
US

V. Phone/Fax

Practice location:
  • Phone: 951-471-4600
  • Fax:
Mailing address:
  • Phone: 951-471-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: