Healthcare Provider Details

I. General information

NPI: 1578655544
Provider Name (Legal Business Name): RACHAEL GUERRA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8605 SANTA MONICA BLVD PMB 444510
WEST HOLLYWOOD CA
90069-4109
US

IV. Provider business mailing address

8605 SANTA MONICA BLVD PMB 444510
WEST HOLLYWOOD CA
90069-4109
US

V. Phone/Fax

Practice location:
  • Phone: 619-215-1889
  • Fax:
Mailing address:
  • Phone: 619-215-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY23965
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: