Provider Demographics
NPI:1225250046
Name:GUERRERO, GINA LEE (MA)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:LEE
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 VIA VICINI
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688
Mailing Address - Country:US
Mailing Address - Phone:949-766-8376
Mailing Address - Fax:
Practice Address - Street 1:14795 JEFFREY ROAD, SUITE 204
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-0416
Practice Address - Country:US
Practice Address - Phone:949-350-0891
Practice Address - Fax:949-559-4590
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC#47046106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist