Provider Demographics
NPI:1417308677
Name:DEALVA-GUERRERO, ROSELLA
Entity Type:Individual
Prefix:
First Name:ROSELLA
Middle Name:
Last Name:DEALVA-GUERRERO
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 1:3350 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-4620
Mailing Address - Country:US
Mailing Address - Phone:562-424-1869
Mailing Address - Fax:
Practice Address - Street 1:3350 OLIVE AVE
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-4620
Practice Address - Country:US
Practice Address - Phone:562-424-1869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7944OtherMEDI-CAL
CA7944Medicaid