Provider Demographics
NPI:1083850846
Name:GASTELUM, GUADALUPE
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:GASTELUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35234 EUREKA AVE
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-4783
Mailing Address - Country:US
Mailing Address - Phone:909-810-7936
Mailing Address - Fax:909-797-2480
Practice Address - Street 1:13800 HEACOCK ST
Practice Address - Street 2:SUITE C236
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-3339
Practice Address - Country:US
Practice Address - Phone:951-653-0819
Practice Address - Fax:951-656-2614
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst