Provider Demographics
NPI:1336912351
Name:GUZMAN, ANISA MARLOUWELLA I
Entity Type:Individual
Prefix:
First Name:ANISA
Middle Name:MARLOUWELLA
Last Name:GUZMAN
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1461 PONTE VEDRA CT
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-6691
Mailing Address - Country:US
Mailing Address - Phone:183-122-8233
Mailing Address - Fax:
Practice Address - Street 1:1461 PONTE VEDRA CT
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6691
Practice Address - Country:US
Practice Address - Phone:183-122-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician