Provider Demographics
NPI:1770245532
Name:GUZMAN, ANGELO ANTHONY
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:ANTHONY
Last Name:GUZMAN
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 1:711 N ARGONNE RD APT 50
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99212-2778
Mailing Address - Country:US
Mailing Address - Phone:347-775-7005
Mailing Address - Fax:
Practice Address - Street 1:618 N SULLIVAN RD STE 21
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8528
Practice Address - Country:US
Practice Address - Phone:509-926-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60983717225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist