Provider Demographics
NPI:1710520531
Name:SERRANO, GUADALUPE (BCBA)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15315 MAGNOLIA BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1172
Mailing Address - Country:US
Mailing Address - Phone:888-353-8285
Mailing Address - Fax:
Practice Address - Street 1:15315 MAGNOLIA BLVD STE 306
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1172
Practice Address - Country:US
Practice Address - Phone:888-353-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-37754106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst