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15720 Ventura Blvd Ste 420 Encino CA 91436-4711 | |
| (818) 927-0478 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 15720 Ventura Blvd Ste 420, Encino, California |
| Authorized Official Name and Position | Crystal Belinda Guzman (OWNER OPERATOR) |
| Authorized Official Contact | 1818748506 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
15720 Ventura Blvd Ste 420 Encino CA 91436-4711 Ph: (818) 748-5060 | 15720 Ventura Blvd Ste 420 Encino CA 91436-4711 Ph: (818) 927-0478 |
| NPI Number | 1801405014 |
|---|---|
| Provider Enumeration Date | 07/24/2020 |
| Last Update Date | 04/24/2024 |
| Certification Date | 04/16/2024 |
| Medicare PECOS PAC ID | 0941746556 |
|---|---|
| Medicare Enrollment ID | O20240719000093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801405014 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Evelyn Xiomara Chamorro |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1750781092 PECOS PAC ID: 3072054287 Enrollment ID: I20240916000703 |
| Provider Name | Modesto Gonzalez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558072926 PECOS PAC ID: 9931648250 Enrollment ID: I20240919001640 |
| Provider Name | Fenela Pagud Pahed |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1902453954 PECOS PAC ID: 6800335225 Enrollment ID: I20241212002672 |
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