Healthcare Provider Details

I. General information

NPI: 1568649077
Provider Name (Legal Business Name): MARICELA GUZMAN ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WILSHIRE BLVD SUITE 500
LOS ANGELES CA
90017-1908
US

IV. Provider business mailing address

3885 CIMARRON ST
LOS ANGELES CA
90062-1026
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-7464
  • Fax:
Mailing address:
  • Phone: 310-850-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberD3784341
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW33069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: