Provider Demographics
NPI:1104034420
Name:GUZMAN, MINERVA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MINERVA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4209
Mailing Address - Country:US
Mailing Address - Phone:323-430-7776
Mailing Address - Fax:
Practice Address - Street 1:12631 IMPERIAL HWY STE C103
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6735
Practice Address - Country:US
Practice Address - Phone:323-430-7776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111901106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA952633765OtherMEDI-CAL