Healthcare Provider Details

I. General information

NPI: 1760084867
Provider Name (Legal Business Name): JAZMINE GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4952 WARNER AVE STE 300
HUNTINGTON BEACH CA
92649-5506
US

IV. Provider business mailing address

1385 S CARL ST
ANAHEIM CA
92806-5604
US

V. Phone/Fax

Practice location:
  • Phone: 877-910-6538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: