Healthcare Provider Details

I. General information

NPI: 1427441872
Provider Name (Legal Business Name): MRS. MARIA GUADALUPE GUEVARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7839 BURGUNDY AVE
LAMONT CA
93241-1338
US

IV. Provider business mailing address

PO BOX 1559
BAKERSFIELD CA
93302-1559
US

V. Phone/Fax

Practice location:
  • Phone: 661-845-5100
  • Fax: 661-845-5106
Mailing address:
  • Phone: 661-635-3050
  • Fax: 661-869-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW107499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: