Provider Demographics
NPI:1790064210
Name:SEBASTIAN, MARIBEL GUZMAN (IMF)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:GUZMAN
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMF
Mailing Address - Street 1:9825 MAGNOLIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3565
Mailing Address - Country:US
Mailing Address - Phone:951-509-2499
Mailing Address - Fax:
Practice Address - Street 1:1012 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:RAMONA
Practice Address - State:CA
Practice Address - Zip Code:92065-2170
Practice Address - Country:US
Practice Address - Phone:760-788-9724
Practice Address - Fax:760-788-9754
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 72695106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist