Provider Demographics
NPI:1003405622
Name:GARCIA, ANDREW LEON GUERRERO
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEON GUERRERO
Last Name:GARCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3534 W BALL RD APT 251
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3678
Mailing Address - Country:US
Mailing Address - Phone:562-507-2629
Mailing Address - Fax:
Practice Address - Street 1:3534 W BALL RD APT 251
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3678
Practice Address - Country:US
Practice Address - Phone:562-507-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician