Healthcare Provider Details

I. General information

NPI: 1497399950
Provider Name (Legal Business Name): NICOLAS GUZMAN BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17842 MAGNOLIA BLVD
ENCINO CA
91316-3317
US

IV. Provider business mailing address

17842 MAGNOLIA BLVD
ENCINO CA
91316-3317
US

V. Phone/Fax

Practice location:
  • Phone: 650-740-1801
  • Fax: 818-748-1772
Mailing address:
  • Phone: 650-740-1801
  • Fax: 818-748-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41563
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: