MEDICARE: MARY GUIRGUIS

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	103TS0200X	School Psychologist		CA

General Provider Information

NPI Number	:	1497534499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GUIRGUIS

Provider Business Mailing Address
First Line	:	16301 BUTTERFIELD RANCH RD UNIT 6203
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-7486
Country	:	US
Telephone Number	:	760-792-6550
Fax Number	:

Provider Business Practice Location Address
First Line	:	16301 BUTTERFIELD RANCH RD UNIT 6203
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-7486
Country	:	US
Telephone Number	:	760-792-6550
Fax Number	:

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

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	09/27/2023

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Directions to “ MARY GUIRGUIS ” Practice Location

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