Provider Demographics
NPI:1902321805
Name:GUAJARDO, CECILIA YOLANDA
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:YOLANDA
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 FINNEY RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-9765
Mailing Address - Country:US
Mailing Address - Phone:209-550-5858
Mailing Address - Fax:
Practice Address - Street 1:2524 FINNEY ROAD
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95358
Practice Address - Country:US
Practice Address - Phone:209-550-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health