Provider Demographics
NPI:1225659741
Name:GUDINO, ALFONSO JR
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:
Last Name:GUDINO
Suffix:JR
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 1:16052 SHARONHILL DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-3556
Mailing Address - Country:US
Mailing Address - Phone:562-399-3858
Mailing Address - Fax:
Practice Address - Street 1:11501 DOLAN AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4921
Practice Address - Country:US
Practice Address - Phone:562-923-7894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10679101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)