Provider Demographics
NPI:1588824130
Name:DE GUZMAN, MARINA P
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:P
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 WOOD CT
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-4129
Mailing Address - Country:US
Mailing Address - Phone:707-647-2757
Mailing Address - Fax:
Practice Address - Street 1:2201 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2524
Practice Address - Country:US
Practice Address - Phone:707-558-1777
Practice Address - Fax:707-558-1770
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health