1578227161 NPI number — JOSE GUERRA, PSYCHOLOGIST PC

Table of content: (NPI 1578227161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578227161 NPI number — JOSE GUERRA, PSYCHOLOGIST PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSE GUERRA, PSYCHOLOGIST PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578227161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CRESCENTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91224-0401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-770-6147
Provider Business Mailing Address Fax Number:
213-232-1008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3031 N SAN FERNANDO BLVD UNIT 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91504-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-770-6147
Provider Business Practice Location Address Fax Number:
213-232-1008
Provider Enumeration Date:
10/28/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GUERRA
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
818-770-6147

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)