Provider Demographics
NPI:1578090114
Name:SARMIENTO, SUYAPA GUADALUPE (PSYD)
Entity Type:Individual
Prefix:
First Name:SUYAPA
Middle Name:GUADALUPE
Last Name:SARMIENTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SUYAP
Other - Middle Name:GUADALUPE
Other - Last Name:SARMIENTO MELGAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:3555 WHIPPLE RD BLDG A2
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-1507
Mailing Address - Country:US
Mailing Address - Phone:510-675-2135
Mailing Address - Fax:
Practice Address - Street 1:3555 WHIPPLE RD BLDG A2
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-1507
Practice Address - Country:US
Practice Address - Phone:510-675-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28991103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical