Basic Information
| Provider Information | |||||||||
| NPI: | 1992336747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AYON-VILLANUEVA | ||||||||
| FirstName: | GUADALUPE | ||||||||
| MiddleName: | YADIRA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12419 GILA RIVER DR | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933125740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619323200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5121 STOCKDALE HWY STE 275 | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933092667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618685000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2020 | ||||||||
| LastUpdateDate: | 01/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.