Provider Demographics
NPI:1497457816
Name:GUITRON, ELENA DEL CARMEN
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:DEL CARMEN
Last Name:GUITRON
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 1:1300 W F ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3501
Mailing Address - Country:US
Mailing Address - Phone:209-847-1324
Mailing Address - Fax:209-847-1392
Practice Address - Street 1:1300 W F ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3501
Practice Address - Country:US
Practice Address - Phone:209-847-1324
Practice Address - Fax:209-847-1392
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA163186183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician