Provider Demographics
NPI:1467964775
Name:GUERRERO LOPEZ, ANDREA GUADALUPE
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:GUADALUPE
Last Name:GUERRERO LOPEZ
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 1:1343 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2333
Mailing Address - Country:US
Mailing Address - Phone:562-375-2472
Mailing Address - Fax:
Practice Address - Street 1:470 E 3RD ST STE A&B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1629
Practice Address - Country:US
Practice Address - Phone:562-375-2472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY3305014Medicaid