Provider Demographics
NPI:1871790030
Name:GUILLEN, LAURA ORTIZ (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ORTIZ
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CANYON OAKS DR
Mailing Address - Street 2:APT. A
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3892
Mailing Address - Country:US
Mailing Address - Phone:510-568-3905
Mailing Address - Fax:
Practice Address - Street 1:2222 BANCROFT EXT
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4300
Practice Address - Country:US
Practice Address - Phone:510-643-2896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21282103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling