MEDICARE: PAOLA GUILLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1083203475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAOLA GUILLEN

Provider Business Mailing Address
First Line	:	1055 E COLORADO BLVD STE 560
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 N TUSTIN ST STE 100
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-7776
Country	:	US
Telephone Number	:	714-965-2324
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2021
Last Update Date	:	01/11/2021

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Directions to “ PAOLA GUILLEN ” Practice Location

Language	Start Address	Practice Location

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