Provider Demographics
NPI:1093888422
Name:GUZMAN, SAMANTHA K (LMT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:K
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7561 CENTER AVE
Mailing Address - Street 2:STE. 15
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3053
Mailing Address - Country:US
Mailing Address - Phone:888-709-7283
Mailing Address - Fax:714-242-7797
Practice Address - Street 1:7561 CENTER AVE
Practice Address - Street 2:STE. 15
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3053
Practice Address - Country:US
Practice Address - Phone:888-709-7283
Practice Address - Fax:714-242-7797
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
412095655OtherEIN