Healthcare Provider Details

I. General information

NPI: 1235065251
Provider Name (Legal Business Name): VICTOR GUZMAN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17505 N 79TH AVE STE 209
GLENDALE AZ
85308-8726
US

IV. Provider business mailing address

4908 W GOLDEN LN
GLENDALE AZ
85302-5020
US

V. Phone/Fax

Practice location:
  • Phone: 623-866-3375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLAC-24052
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: