Healthcare Provider Details

I. General information

NPI: 1942769880
Provider Name (Legal Business Name): SANDRA GUILLEN PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S. POPLAR ST.
SANTA ANA CA
92704
US

IV. Provider business mailing address

1718 OAK ST
SANTA ANA CA
92707-2325
US

V. Phone/Fax

Practice location:
  • Phone: 714-433-3483
  • Fax:
Mailing address:
  • Phone: 714-586-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC19915
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: