MEDICARE: LESLIE ANN SIERRA GUZMAN SP

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	235Z00000X	Speech-Language Pathologist	17392	CA

General Provider Information

NPI Number	:	1962644575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ANN SIERRA GUZMAN SP

Provider Business Mailing Address
First Line	:	13840 ROSECRANS AVE
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-5208
Country	:	US
Telephone Number	:	562-305-0160
Fax Number	:	562-802-3785

Provider Business Practice Location Address
First Line	:	13840 ROSECRANS AVE
Second Line	:
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-5208
Country	:	US
Telephone Number	:	562-305-0160
Fax Number	:	562-802-3785

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

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	06/03/2013

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