Healthcare Provider Details

I. General information

NPI: 1699402990
Provider Name (Legal Business Name): GUADALUPE GALLEGO BOGARIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 J ST
SACRAMENTO CA
95811-3010
US

IV. Provider business mailing address

1820 J ST
SACRAMENTO CA
95811-3010
US

V. Phone/Fax

Practice location:
  • Phone: 916-550-5481
  • Fax: 916-822-8974
Mailing address:
  • Phone: 916-550-5481
  • Fax: 916-822-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1501430323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: