Healthcare Provider Details

I. General information

NPI: 1932784329
Provider Name (Legal Business Name): KIMBERLEE NISELA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 E LIVE OAK AVE STE E
ARCADIA CA
91006-5600
US

IV. Provider business mailing address

15518 LAWNWOOD ST
LA PUENTE CA
91744-2926
US

V. Phone/Fax

Practice location:
  • Phone: 626-538-2751
  • Fax: 626-538-2753
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: