Provider Demographics
NPI:1659148690
Name:GUZMAN, ALTHEA ANGELIQUE VILLARIN (PPSC)
Entity Type:Individual
Prefix:
First Name:ALTHEA ANGELIQUE
Middle Name:VILLARIN
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41041 TRIMBOLI WAY UNIT 1086
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-8007
Mailing Address - Country:US
Mailing Address - Phone:510-304-4568
Mailing Address - Fax:
Practice Address - Street 1:1055 S MONROE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3150
Practice Address - Country:US
Practice Address - Phone:408-556-0360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1185611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical