Provider Demographics
NPI:1891829230
Name:GUERRERO, ENRIQUE (MA)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3354 SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2542
Mailing Address - Country:US
Mailing Address - Phone:323-919-3816
Mailing Address - Fax:818-376-1437
Practice Address - Street 1:6931 VAN NUYS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3980
Practice Address - Country:US
Practice Address - Phone:818-376-0134
Practice Address - Fax:818-376-1437
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X, 225400000X
CAAMFT128450106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner