Provider Demographics
NPI:1124659370
Name:GUERRA, CELIANA VARGAS (ATC)
Entity type:Individual
Prefix:
First Name:CELIANA
Middle Name:VARGAS
Last Name:GUERRA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 S BUBBLING WELL RD
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-5004
Mailing Address - Country:US
Mailing Address - Phone:626-918-9507
Mailing Address - Fax:
Practice Address - Street 1:463 S HOLLENBECK AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2999
Practice Address - Country:US
Practice Address - Phone:626-974-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000262382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer