Healthcare Provider Details

I. General information

NPI: 1700407160
Provider Name (Legal Business Name): ANTHONY JAMES GUERRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WILLOW PLZ STE 409
VISALIA CA
93291-6236
US

IV. Provider business mailing address

100 WILLOW PLZ STE 409
VISALIA CA
93291-6236
US

V. Phone/Fax

Practice location:
  • Phone: 559-372-0523
  • Fax:
Mailing address:
  • Phone: 559-372-0523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number120755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: