Healthcare Provider Details

I. General information

NPI: 1447506753
Provider Name (Legal Business Name): GUADALUPE PRECIADO RODISHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GUADALUPE PRECIADO

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 PICO BLVD
SANTA MONICA CA
90405-1325
US

IV. Provider business mailing address

909 PICO BLVD
SANTA MONICA CA
90405-1326
US

V. Phone/Fax

Practice location:
  • Phone: 310-314-6200
  • Fax: 310-638-9080
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN161104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: