Provider Demographics
NPI:1316135858
Name:AVALOS, GUADALUPE (MA)
Entity type:Individual
Prefix:MRS
First Name:GUADALUPE
Middle Name:
Last Name:AVALOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:GUADALUPE
Other - Middle Name:
Other - Last Name:OROZCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1830 S CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4418
Mailing Address - Country:US
Mailing Address - Phone:559-730-2969
Mailing Address - Fax:
Practice Address - Street 1:1830 S CENTRAL ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4418
Practice Address - Country:US
Practice Address - Phone:559-730-2969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-10
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 75451106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist