Provider Demographics
NPI:1386086767
Name:EMERICK, GUADALUPE VICTORIA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:GUADALUPE
Middle Name:VICTORIA
Last Name:EMERICK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:GUADALUPE
Other - Middle Name:VICTORIA
Other - Last Name:EMERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:416 COLORADO AVE APT D
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4029
Mailing Address - Country:US
Mailing Address - Phone:196-646-6662
Mailing Address - Fax:
Practice Address - Street 1:2865 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-2411
Practice Address - Country:US
Practice Address - Phone:619-232-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416Medicare PIN