Provider Demographics
NPI:1952539652
Name:GUZMAN, CARLOS (BA)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2920
Mailing Address - Country:US
Mailing Address - Phone:760-482-0864
Mailing Address - Fax:760-482-9185
Practice Address - Street 1:680 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2920
Practice Address - Country:US
Practice Address - Phone:760-482-0864
Practice Address - Fax:760-482-9185
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor