Healthcare Provider Details

I. General information

NPI: 1912861477
Provider Name (Legal Business Name): NICOLE GUILARDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 AMBER VALLEY DR
WHITTIER CA
90604-4051
US

IV. Provider business mailing address

16200 AMBER VALLEY DR
WHITTIER CA
90604-4051
US

V. Phone/Fax

Practice location:
  • Phone: 818-472-8475
  • Fax:
Mailing address:
  • Phone: 818-472-8475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: