Provider Demographics
NPI:1689984361
Name:DIAZ-GUEVARA, MARIA GUADALUPE
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:GUADALUPE
Last Name:DIAZ-GUEVARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GUADALUPE
Other - Middle Name:
Other - Last Name:DIAZ GUEVARA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1801 PARK COURT PL BLDG H
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5028
Mailing Address - Country:US
Mailing Address - Phone:714-371-6082
Mailing Address - Fax:714-730-8212
Practice Address - Street 1:1804 PARK COURT PLACE
Practice Address - Street 2:SUITE H
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-957-1004
Practice Address - Fax:714-550-9658
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes172V00000XOther Service ProvidersCommunity Health Worker