Healthcare Provider Details

I. General information

NPI: 1487832283
Provider Name (Legal Business Name): JOSE EFRAIN GUEVARA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9603 CALIFORNIA AVE
SOUTH GATE CA
90280-4523
US

IV. Provider business mailing address

9603 CALIFORNIA AVE
SOUTH GATE CA
90280-4523
US

V. Phone/Fax

Practice location:
  • Phone: 323-607-8712
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number163231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: