Healthcare Provider Details

I. General information

NPI: 1003975855
Provider Name (Legal Business Name): SHANDRA GUZMAN PARK LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 MACARTHUR BLVD STE 208
SAN LEANDRO CA
94577-3014
US

IV. Provider business mailing address

1057 MACARTHUR BLVD STE 208
SAN LEANDRO CA
94577-3014
US

V. Phone/Fax

Practice location:
  • Phone: 510-283-9499
  • Fax: 650-231-2707
Mailing address:
  • Phone: 510-283-9499
  • Fax: 650-231-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number77627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: