Provider Demographics
NPI:1093417362
Name:GUZMAN, MARIA ELENA (SUDRC-18013)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:SUDRC-18013
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17822 BEACH BLVD STE 278
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7180
Mailing Address - Country:US
Mailing Address - Phone:714-375-3795
Mailing Address - Fax:714-375-3796
Practice Address - Street 1:17822 BEACH BLVD STE 278
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7180
Practice Address - Country:US
Practice Address - Phone:714-375-3795
Practice Address - Fax:714-375-3796
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASUDRC-18013101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)