Healthcare Provider Details

I. General information

NPI: 1689534547
Provider Name (Legal Business Name): GUILLERMO SIORDIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 S WESTERN AVE
LOS ANGELES CA
90062-1105
US

IV. Provider business mailing address

9345 3/4 WASHBURN RD
DOWNEY CA
90242-2910
US

V. Phone/Fax

Practice location:
  • Phone: 323-290-4367
  • Fax:
Mailing address:
  • Phone: 562-583-9207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: