Active NPI
Guadalupe Vaca, M.S. DEGREE
- Marriage & Family Therapist
- Fresno, CA
National Provider Identifier
1366584336
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 42966
- Practice address
- 5588 N Palm Ave
Fresno, CA 93704-1913 - Phone
- (559) 804-4599
- Fax
- (559) 775-2556
- NPI assigned
- Feb 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 42966 | CA | |
| Marriage & Family Therapist | 106H00000X | 42966 | CA | Primary |
Addresses
Primary practice location
5588 N Palm Ave
Fresno, CA 93704-1913
Mailing address
5588 N Palm Ave
Fresno, CA 93704-1913
Phone (559) 804-4599
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 22, 2024 through Jan 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42966 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709424000000",
"number": "1366584336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5588 N PALM AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937041913",
"telephone_number": "559-804-4599",
"fax_number": "559-775-2556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5588 N PALM AVE",
"city": "FRESNO",
"state": "CA",
"postal_code": "937041913",
"telephone_number": "559-804-4599",
"fax_number": "559-775-2556"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VACA",
"first_name": "GUADALUPE",
"name_prefix": "Mrs.",
"credential": "M.S. DEGREE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-13",
"last_updated": "2024-03-03",
"certification_date": "2024-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "42966",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "42966",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.