Provider Demographics
NPI:1528563046
Name:LOPEZ GUERRERO, PAOLA E
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:E
Last Name:LOPEZ 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 1:1929 BEECHWOOD DR APT B
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-6404
Mailing Address - Country:US
Mailing Address - Phone:805-975-8698
Mailing Address - Fax:
Practice Address - Street 1:1016 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5333
Practice Address - Country:US
Practice Address - Phone:805-456-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-18-29350103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst