Provider Demographics
NPI:1801642418
Name:GUETA, MARIBEL
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:GUETA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:
Other - Last Name:GUETA-OTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4120 E 1ST ST APT 6
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-7611
Mailing Address - Country:US
Mailing Address - Phone:323-949-4511
Mailing Address - Fax:
Practice Address - Street 1:4120 E 1ST ST APT 6
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-7611
Practice Address - Country:US
Practice Address - Phone:323-949-4511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2024013041363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health