Provider Demographics
NPI:1740753748
Name:GUZMAN-FIX, STEPHANIE L (MA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:GUZMAN-FIX
Suffix:
Gender:F
Credentials:MA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 LAKE HEIGHTS DR APT D104
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6060
Mailing Address - Country:US
Mailing Address - Phone:425-736-9530
Mailing Address - Fax:
Practice Address - Street 1:4308 76TH ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-3720
Practice Address - Country:US
Practice Address - Phone:425-349-7352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACM60379774246Z00000X, 246ZX2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other