Basic Information
| Provider Information | |||||||||
| NPI: | 1932837630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUIRGIUS | ||||||||
| FirstName: | AMORA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4055 E HAMILTON PASEO | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917612673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099082687 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 CORPORATE CENTER DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917682627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096180974 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2022 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.