Healthcare Provider Details

I. General information

NPI: 1679110571
Provider Name (Legal Business Name): FELICIA GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 RIDDER PARK DR
SAN JOSE CA
95131-2313
US

IV. Provider business mailing address

1356 RIDDER PARK DR
SAN JOSE CA
95131-2313
US

V. Phone/Fax

Practice location:
  • Phone: 408-225-9291
  • Fax:
Mailing address:
  • Phone: 408-225-9291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: