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General NPI Number Information
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NPI Number | 1174649610
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Entity Type | Individual
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Provider Name | JOSE LUIS GUERRA PSYD MFT
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 3031 N SAN FERNANDO BLVD STE 100
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City | BURBANK
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State | CA
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Zip | 91504-4704
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Country | US
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Telephone | 818-770-6147
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Fax | 213-232-1008
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Provider Business Mailing Address
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Address Line | PO BOX 8401
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City | LA CRESCENTA
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State | CA
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Zip | 91224-0401
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Country | US
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Telephone | 818-770-6147
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 32906
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT50145
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License Number State | CA
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