Healthcare Provider Details

I. General information

NPI: 1922931245
Provider Name (Legal Business Name): LIANA MARIE GUEVARA HARTLEP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 HOWARD ST
SAN FRANCISCO CA
94103-2525
US

IV. Provider business mailing address

1433 CLAY ST APT 8
SAN FRANCISCO CA
94109-3930
US

V. Phone/Fax

Practice location:
  • Phone: 415-617-9357
  • Fax:
Mailing address:
  • Phone: 415-360-9357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: