Provider Demographics
NPI:1639523111
Name:GUERRERO, LUIS
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17200 VENTURA BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4030
Mailing Address - Country:US
Mailing Address - Phone:818-501-0822
Mailing Address - Fax:818-501-0820
Practice Address - Street 1:17200 VENTURA BLVD STE 125
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4030
Practice Address - Country:US
Practice Address - Phone:818-501-0822
Practice Address - Fax:818-501-0820
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1052547103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst