Provider Demographics
NPI:1265679732
Name:GUZMAN, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9C MAREA AVE
Mailing Address - Street 2:
Mailing Address - City:LA SELVA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:95076-1726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9C MAREA AVE
Practice Address - Street 2:
Practice Address - City:LA SELVA BEACH
Practice Address - State:CA
Practice Address - Zip Code:95076-1726
Practice Address - Country:US
Practice Address - Phone:831-688-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health