Provider Demographics
NPI:1578294732
Name:CABEZAS GUERRA, CHRISTIAN BENJAMIN
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:BENJAMIN
Last Name:CABEZAS GUERRA
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 1:11496 SANDCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-5017
Mailing Address - Country:US
Mailing Address - Phone:763-370-1282
Mailing Address - Fax:
Practice Address - Street 1:797 7TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5070
Practice Address - Country:US
Practice Address - Phone:651-379-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306384101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)