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General NPI Number Information
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NPI Number | 1932029725
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Entity Type | Organization
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Legal Business Name | GUADALUPE MEDICAL GROUP A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 4201 E 10TH ST
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City | LONG BEACH
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State | CA
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Zip | 90804-5508
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Country | US
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Telephone | 323-543-4535
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Fax | 323-480-4574
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Provider Business Mailing Address
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Address Line | 4525 EAGLE ROCK BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90041-3214
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Country | US
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Telephone | 818-846-4469
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Fax |
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Authorized Official
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Title or Position | OPERATING PROVIDER
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Name | MR. TEODULO CRUZ BONZON
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Credential | LCSW
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Telephone | 818-846-4469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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