Provider Demographics
NPI:1215282090
Name:SARMIENTO, GUADALUPE GARCIA (OT)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:GARCIA
Last Name:SARMIENTO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-5310
Mailing Address - Country:US
Mailing Address - Phone:520-881-8940
Mailing Address - Fax:
Practice Address - Street 1:2800 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5310
Practice Address - Country:US
Practice Address - Phone:520-881-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11535225XP0200X
AZ6373225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics