Provider Demographics
NPI:1225252398
Name:GUZMAN ZAVALA, JORGE
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:GUZMAN ZAVALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JORGE
Other - Middle Name:
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 6222
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91802-6222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 N LAKE AVE STE 800
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1870
Practice Address - Country:US
Practice Address - Phone:650-394-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 390200000X
CALMFT 79776106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA79776OtherBBS LICENSE MARRIAGE AND FAMILY THERAPIST