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1952786972 NPI number — GUADALUPE MARIE NAMBO-BASUA LMFT

NPI Number: 1952786972
Health Care Provider/Practitioner: GUADALUPE MARIE NAMBO-BASUA LMFT

Information about “1952786972” NPI (GUADALUPE MARIE NAMBO-BASUA LMFT) exists in 1952786972 in HTML format HTML  |  1952786972 in plain Text format TXT  |  1952786972 in PDF (Portable Document Format) PDF  |  1952786972 in an XML format XML  formats.

NPI Number : 1952786972 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952786972",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NAMBO-BASUA",
    "FirstName": "GUADALUPE",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMFT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "NAMBO",
    "OtherFirstName": "GUADALUPE",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3436 AMERICAN RIVER DR STE 8A",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SACRAMENTO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95864-5793",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "916-237-7457",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3436 AMERICAN RIVER DR STE 8A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SACRAMENTO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95864-5793",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "916-237-7457",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/21/2015",
    "LastUpdateDate": "02/13/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "01/12/2021",
    "NPIReactivationDate": "03/24/2022",
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "106H00000X",
        "TaxonomyName": "Marriage & Family Therapist",
        "LicenseNumber": "1110850",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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