Healthcare Provider Details

I. General information

NPI: 1073496295
Provider Name (Legal Business Name): KENNETH JESIEL GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41769 11TH ST W STE A
PALMDALE CA
93551-1418
US

IV. Provider business mailing address

38709 SUMAC AVE
PALMDALE CA
93550-3739
US

V. Phone/Fax

Practice location:
  • Phone: 661-947-9554
  • Fax:
Mailing address:
  • Phone: 661-341-4617
  • 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: