Provider Demographics
NPI:1932296779
Name:GUEVARA, MARY MONICA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY MONICA
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MONICA
Other - Middle Name:V
Other - Last Name:GUEVARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:15123 LA CALMA DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1619
Mailing Address - Country:US
Mailing Address - Phone:562-900-0627
Mailing Address - Fax:
Practice Address - Street 1:6737 BRIGHT AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4300
Practice Address - Country:US
Practice Address - Phone:562-900-0627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13909103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical