Healthcare Provider Details

I. General information

NPI: 1134839624
Provider Name (Legal Business Name): CRISTIAN GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2022
Last Update Date: 11/25/2022
Certification Date: 11/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15720 VENTURA BLVD STE 420
ENCINO CA
91436-4711
US

IV. Provider business mailing address

5069 W 20TH ST APT 3
LOS ANGELES CA
90016-1442
US

V. Phone/Fax

Practice location:
  • Phone: 818-927-0478
  • Fax:
Mailing address:
  • Phone: 224-280-5807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: