Provider Demographics
NPI:1669201778
Name:ESTRADA GUZMAN, MASSIEL
Entity type:Individual
Prefix:
First Name:MASSIEL
Middle Name:
Last Name:ESTRADA GUZMAN
Suffix:
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 1:3835 NW 185TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2844
Mailing Address - Country:US
Mailing Address - Phone:786-537-3247
Mailing Address - Fax:
Practice Address - Street 1:3835 NW 185TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2844
Practice Address - Country:US
Practice Address - Phone:786-537-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician