Healthcare Provider Details

I. General information

NPI: 1720100316
Provider Name (Legal Business Name): ANDREA FELICE GUZMAN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 CARDINAL LN
SAN DIEGO CA
92123-3743
US

IV. Provider business mailing address

269 AVENTURA DR 8
CHULA VISTA CA
91914-4470
US

V. Phone/Fax

Practice location:
  • Phone: 619-829-3050
  • Fax:
Mailing address:
  • Phone: 310-612-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number45958
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number45958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: