Provider Demographics
NPI:1003647744
Name:GUADARRAMA, MAKAELA AURORA
Entity type:Individual
Prefix:MISS
First Name:MAKAELA
Middle Name:AURORA
Last Name:GUADARRAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 CREEKSIDE RIDGE DR STE 280
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 BIGGS EAST HWY
Practice Address - Street 2:
Practice Address - City:BIGGS
Practice Address - State:CA
Practice Address - Zip Code:95917-9734
Practice Address - Country:US
Practice Address - Phone:530-821-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician