Provider Demographics
NPI:1275762643
Name:DE GUZMAN, EDUARDO A (MA)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:A
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 FOLSOM ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3325
Mailing Address - Country:US
Mailing Address - Phone:415-845-7222
Mailing Address - Fax:
Practice Address - Street 1:2675 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3325
Practice Address - Country:US
Practice Address - Phone:415-845-7222
Practice Address - Fax:415-643-7118
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI #60462106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist