Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 225XM0800X | Mental Health |
NPI | 1942780978 |
---|---|
Provider Name | Mr. Ruben Guerrero JR. |
First Address | Downey, CA 90241 |
Second Address | Orange, CA 92868-3205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2018 |
Last Update Date | 18/09/2019 |