Provider Demographics
NPI:1013713726
Name:GUZMAN DAVILA, GENESIS CRYSTAL
Entity type:Individual
Prefix:
First Name:GENESIS
Middle Name:CRYSTAL
Last Name:GUZMAN DAVILA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16A PROSPERITY LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7409
Mailing Address - Country:US
Mailing Address - Phone:386-302-8835
Mailing Address - Fax:
Practice Address - Street 1:8 WILDWOOD LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-3221
Practice Address - Country:US
Practice Address - Phone:386-227-6485
Practice Address - Fax:866-244-7179
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician