MEDICARE: MR. CARLOS GUZMAN BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1952539652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARLOS GUZMAN BA

Provider Business Mailing Address
First Line	:	680 W MAIN ST
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2920
Country	:	US
Telephone Number	:	760-482-0864
Fax Number	:	760-482-9185

Provider Business Practice Location Address
First Line	:	680 W MAIN ST
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2920
Country	:	US
Telephone Number	:	760-482-0864
Fax Number	:	760-482-9185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	07/05/2011

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