Healthcare Provider Details

I. General information

NPI: 1497226807
Provider Name (Legal Business Name): STEPHANIE GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 WILSON RD
BAKERSFIELD CA
93304-5319
US

IV. Provider business mailing address

1400 S UNION AVE STE 100
BAKERSFIELD CA
93307-4179
US

V. Phone/Fax

Practice location:
  • Phone: 661-324-4756
  • Fax: 661-617-2099
Mailing address:
  • Phone: 661-324-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: