Provider Demographics
NPI:1053787705
Name:LAO, SHENTELYN GUINILING (CADC-III)
Entity type:Individual
Prefix:
First Name:SHENTELYN
Middle Name:GUINILING
Last Name:LAO
Suffix:
Gender:F
Credentials:CADC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11161 CAMINO RUIZ
Mailing Address - Street 2:APT. 47
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1765
Mailing Address - Country:US
Mailing Address - Phone:858-397-4500
Mailing Address - Fax:
Practice Address - Street 1:550 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1643
Practice Address - Country:US
Practice Address - Phone:760-489-6380
Practice Address - Fax:760-294-7022
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)