Provider Demographics
NPI:1548703101
Name:GUADALUPE, JOSE
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:GUADALUPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23888 CONNECTICUT ST STE 12
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1638
Mailing Address - Country:US
Mailing Address - Phone:510-361-9405
Mailing Address - Fax:
Practice Address - Street 1:2015 PIONEER CT
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1781
Practice Address - Country:US
Practice Address - Phone:510-361-9405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)