Provider Demographics
NPI:1376911131
Name:GUIA, BERNADETTE DE LARA (NP)
Entity Type:Individual
Prefix:MISS
First Name:BERNADETTE
Middle Name:DE LARA
Last Name:GUIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8215 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4810
Mailing Address - Country:US
Mailing Address - Phone:818-901-0373
Mailing Address - Fax:818-782-7320
Practice Address - Street 1:8215 VAN NUYS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4810
Practice Address - Country:US
Practice Address - Phone:818-901-0373
Practice Address - Fax:818-782-7320
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily