Healthcare Provider Details

I. General information

NPI: 1184744724
Provider Name (Legal Business Name): PATRICIA GUERRERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 W LINNE RD # J-23
TRACY CA
95377-8024
US

IV. Provider business mailing address

2809 HAWKINS LN
TRACY CA
95377-2205
US

V. Phone/Fax

Practice location:
  • Phone: 209-640-1892
  • Fax: 209-221-7029
Mailing address:
  • Phone: 209-832-9213
  • Fax: 209-526-0908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number46476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: