Provider Demographics
NPI:1104044478
Name:GUILLMENO, DEBORA LINDSEY
Entity Type:Individual
Prefix:MS
First Name:DEBORA
Middle Name:LINDSEY
Last Name:GUILLMENO
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 1:3137 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-5228
Mailing Address - Country:US
Mailing Address - Phone:323-971-6077
Mailing Address - Fax:310-603-0098
Practice Address - Street 1:3137 W 75TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-5228
Practice Address - Country:US
Practice Address - Phone:323-971-6077
Practice Address - Fax:310-603-0098
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)