Healthcare Provider Details

I. General information

NPI: 1700431236
Provider Name (Legal Business Name): PATRICIA GUERRERO TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 POMONA BLVD STE 109
LOS ANGELES CA
90022-1789
US

IV. Provider business mailing address

817 W BEVERLY BLVD STE 201
MONTEBELLO CA
90640-4265
US

V. Phone/Fax

Practice location:
  • Phone: 323-895-7872
  • Fax: 323-782-3333
Mailing address:
  • Phone: 562-927-5820
  • Fax: 562-684-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberOTA4908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: