Provider Demographics
NPI:1902965445
Name:GUAJARDO-GONZALEZ, TONI (PHD)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:GUAJARDO-GONZALEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 E DEL MAR BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4321
Mailing Address - Country:US
Mailing Address - Phone:626-568-8336
Mailing Address - Fax:626-568-9276
Practice Address - Street 1:2810 E DEL MAR BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4321
Practice Address - Country:US
Practice Address - Phone:626-568-8336
Practice Address - Fax:626-568-9276
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11438103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP11438AMedicare ID - Type Unspecified
R16486Medicare UPIN