Provider Demographics
NPI:1891539086
Name:GUDINO, LUIS (NP)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:GUDINO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S HOLLISTON AVE UNIT 308
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3480
Mailing Address - Country:US
Mailing Address - Phone:818-919-9813
Mailing Address - Fax:
Practice Address - Street 1:222 S HOLLISTON AVE UNIT 308
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3480
Practice Address - Country:US
Practice Address - Phone:818-919-9813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030525363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health