MEDICARE: GUADALUPE ONTIVEROS

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	106E00000X	Assistant Behavior Analyst		CA

General Provider Information

NPI Number	:	1831947043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUADALUPE ONTIVEROS

Provider Business Mailing Address
First Line	:	333 UNIVERSITY AVE STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-6540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9511 LITTLE RAPIDS WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7804
Country	:	US
Telephone Number	:	559-726-9046
Fax Number	:

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

Provider Enumeration Date	:	05/11/2024
Last Update Date	:	05/17/2024

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Directions to “ GUADALUPE ONTIVEROS ” Practice Location

Language	Start Address	Practice Location

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