Healthcare Provider Details

I. General information

NPI: 1861103111
Provider Name (Legal Business Name): ALFONSO GUZMAN ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2022
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 CHELSEA ST
RIDGECREST CA
93555-3208
US

IV. Provider business mailing address

1141 CHELSEA ST
RIDGECREST CA
93555-3208
US

V. Phone/Fax

Practice location:
  • Phone: 760-463-2880
  • Fax:
Mailing address:
  • Phone: 760-463-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: