Provider Demographics
NPI:1619417359
Name:GUZMAN, SANDRA MARISOL
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARISOL
Last Name: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 1:4618 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1977
Mailing Address - Country:US
Mailing Address - Phone:323-953-7170
Mailing Address - Fax:323-663-2379
Practice Address - Street 1:4618 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1977
Practice Address - Country:US
Practice Address - Phone:323-953-7170
Practice Address - Fax:323-663-2379
Is Sole Proprietor?:No
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker