Healthcare Provider Details

I. General information

NPI: 1326797317
Provider Name (Legal Business Name): LYNDA MICHELLE GUZMAN RADT1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BARSTOW RD
BARSTOW CA
92311-2903
US

IV. Provider business mailing address

1917 FORANE ST
BARSTOW CA
92311-5724
US

V. Phone/Fax

Practice location:
  • Phone: 760-255-1083
  • Fax:
Mailing address:
  • Phone: 760-261-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: