Provider Demographics
NPI:1447085584
Name:GUERRA, KARISSA (PPS)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:GUERRA
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W D ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3026
Mailing Address - Country:US
Mailing Address - Phone:909-459-2500
Mailing Address - Fax:
Practice Address - Street 1:1390 W FRANCIS ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6014
Practice Address - Country:US
Practice Address - Phone:909-988-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210163213101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool