Healthcare Provider Details

I. General information

NPI: 1275762643
Provider Name (Legal Business Name): EDUARDO A. DE GUZMAN M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 FOLSOM ST
SAN FRANCISCO CA
94110-3325
US

IV. Provider business mailing address

2675 FOLSOM ST
SAN FRANCISCO CA
94110-3325
US

V. Phone/Fax

Practice location:
  • Phone: 415-845-7222
  • Fax: 415-643-7118
Mailing address:
  • Phone: 415-845-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFTI #60462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: