Healthcare Provider Details

I. General information

NPI: 1265365894
Provider Name (Legal Business Name): ELENA RAQUEL GUZMAN CMPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81346 AVENIDA TORTUGA
INDIO CA
92201-7821
US

IV. Provider business mailing address

81346 AVENIDA TORTUGA
INDIO CA
92201-7821
US

V. Phone/Fax

Practice location:
  • Phone: 760-906-0156
  • Fax:
Mailing address:
  • Phone: 760-906-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-DYCQZA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: