MEDICARE: KIMBERLY ANN GUAJARDO

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	103TC0700X	Clinical Psychologist	PSY19975	CA

General Provider Information

NPI Number	:	1801938824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN GUAJARDO

Provider Business Mailing Address
First Line	:	3455 PERCY ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1716
Country	:	US
Telephone Number	:	323-268-2100
Fax Number	:	323-268-2460

Provider Business Practice Location Address
First Line	:	4063 WHITTIER BLVD
Second Line	:	#202
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2536
Country	:	US
Telephone Number	:	323-644-2000
Fax Number	:

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	10/05/2015

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Directions to “ KIMBERLY ANN GUAJARDO ” Practice Location

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