Healthcare Provider Details

I. General information

NPI: 1538528583
Provider Name (Legal Business Name): MARCELINO GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 DOLAN AVE
DOWNEY CA
90241-4921
US

IV. Provider business mailing address

11501 DOLAN AVE
DOWNEY CA
90241-4921
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-7894
  • Fax: 562-869-3400
Mailing address:
  • Phone: 562-923-7894
  • Fax: 562-869-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC2741214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: