Provider Demographics
NPI:1457195398
Name:PINA AMBRIZ, GUADALUPE FERNANDA
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:FERNANDA
Last Name:PINA AMBRIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 BELL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-1623
Mailing Address - Country:US
Mailing Address - Phone:805-760-2009
Mailing Address - Fax:
Practice Address - Street 1:6833 STOCKTON BLVD STE 485
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2376
Practice Address - Country:US
Practice Address - Phone:916-942-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA372600000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes372600000XNursing Service Related ProvidersAdult Companion