Provider Demographics
NPI:1417602434
Name:IGNACIO, GUADALUPE MANAGUIT
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:MANAGUIT
Last Name:IGNACIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GUADALUPE
Other - Middle Name:M
Other - Last Name:IGNACIO-EDGAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5804 ALTAMONT DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-1506
Mailing Address - Country:US
Mailing Address - Phone:619-316-5523
Mailing Address - Fax:
Practice Address - Street 1:2970 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-3296
Practice Address - Country:US
Practice Address - Phone:619-236-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)