Provider Demographics
NPI:1154943926
Name:GUAJARDO, SUSAN (RN-REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:RN-REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5776 LINDERO CANYON RD STE D-361
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-6428
Mailing Address - Country:US
Mailing Address - Phone:805-217-8733
Mailing Address - Fax:805-272-9382
Practice Address - Street 1:2695 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-5534
Practice Address - Country:US
Practice Address - Phone:805-217-8733
Practice Address - Fax:805-272-9382
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556522163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management