Provider Demographics
NPI:1164836672
Name:MARIN GUERRERO, ROSMERI (PSYD)
Entity Type:Individual
Prefix:MISS
First Name:ROSMERI
Middle Name:
Last Name:MARIN GUERRERO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12140 ALLIN ST
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5805
Mailing Address - Country:US
Mailing Address - Phone:310-895-4624
Mailing Address - Fax:
Practice Address - Street 1:6851 LENNOX AVE STE 100
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4076
Practice Address - Country:US
Practice Address - Phone:818-739-5400
Practice Address - Fax:818-442-0290
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225C00000X
390200000X
CAPSY31236103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program