Provider Demographics
NPI:1720100316
Name:GUZMAN, ANDREA FELICE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:FELICE
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 AVENTURA DR
Mailing Address - Street 2:8
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4470
Mailing Address - Country:US
Mailing Address - Phone:310-612-2811
Mailing Address - Fax:
Practice Address - Street 1:2351 CARDINAL LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3743
Practice Address - Country:US
Practice Address - Phone:619-829-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45958305R00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007570Medicaid
CASUBB036OtherLA DMH PROVIDER