Healthcare Provider Details

I. General information

NPI: 1598337131
Provider Name (Legal Business Name): LESLIE GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 W BROADWAY
GLENDALE CA
91204-1010
US

IV. Provider business mailing address

1063 MCGAW AVE STE 100
IRVINE CA
92614-5554
US

V. Phone/Fax

Practice location:
  • Phone: 818-551-0128
  • Fax:
Mailing address:
  • Phone: 949-688-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number103K00000X
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: