Provider Demographics
NPI:1982279378
Name:CONTRERAS, GUILLERMO (NONE)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:NONE
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Mailing Address - Street 1:18726 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-3813
Mailing Address - Country:US
Mailing Address - Phone:310-856-0800
Mailing Address - Fax:187-269-0248
Practice Address - Street 1:5060 CALIFORNIA AVE SUITE 610, BAKERSFIELD, CA 93309
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-258-3240
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician