Provider Demographics
NPI:1356831952
Name:GUADALUPE, WILLIE JOSHUA (BCBA)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:JOSHUA
Last Name:GUADALUPE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7141 WOODLEY AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3932
Mailing Address - Country:US
Mailing Address - Phone:818-285-8252
Mailing Address - Fax:
Practice Address - Street 1:7141 WOODLEY AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3932
Practice Address - Country:US
Practice Address - Phone:818-285-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1-20-45897OtherBACB
RBT-17-28343OtherRBT
FL018000200Medicaid