Healthcare Provider Details

I. General information

NPI: 1275007387
Provider Name (Legal Business Name): MR. JOJO ANDY GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23161 MILL CREEK DR STE 203
LAGUNA HILLS CA
92653-7908
US

IV. Provider business mailing address

23161 MILL CREEK DR
LAGUNA HILLS CA
92653-7908
US

V. Phone/Fax

Practice location:
  • Phone: 949-264-5350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: