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General NPI Number Information
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NPI Number | 1730655176
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Entity Type | Individual
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Provider Name | GLADYS CECELIA GUEVARA CATC III
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Gender | Female
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 18612 SANTA ANA AVE
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City | BLOOMINGTON
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State | CA
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Zip | 92316-2636
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Country | US
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Telephone | 909-546-8099
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 RIALTO AVE
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City | COLTON
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State | CA
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Zip | 92324-2433
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Country | US
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Telephone | 909-835-7482
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | R1490871122
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 14699
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | CA
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