Healthcare Provider Details

I. General information

NPI: 1073133427
Provider Name (Legal Business Name): ABIGAIL GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 HUNTE PKWY
CHULA VISTA CA
91914-3622
US

IV. Provider business mailing address

242 BRANDYWOOD ST
SAN DIEGO CA
92114-5848
US

V. Phone/Fax

Practice location:
  • Phone: 619-292-8343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: