Active NPI
Kimberly Ann Guajardo
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1801938824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY19975
- Practice address
- 4063 Whittier Blvd
#202
Los Angeles, CA 90023-2536 - Phone
- (323) 644-2000
- NPI assigned
- Feb 13, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY19975 | CA | Primary |
Addresses
Primary practice location
4063 Whittier Blvd
#202
Los Angeles, CA 90023-2536
Mailing address
3455 Percy St
Los Angeles, CA 90023-1716
Phone (323) 268-2100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY19975 | CA | MD | Clinical Psychologist |
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": "1444003200000",
"number": "1801938824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3455 PERCY ST",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900231716",
"telephone_number": "323-268-2100",
"fax_number": "323-268-2460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4063 WHITTIER BLVD",
"address_2": "#202",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900232536",
"telephone_number": "323-644-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUAJARDO",
"first_name": "KIMBERLY",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-13",
"last_updated": "2015-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY19975",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.