Healthcare Provider Details

I. General information

NPI: 1497243927
Provider Name (Legal Business Name): LUIS GUZMAN GARCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 CROW CANYON PL STE 205
SAN RAMON CA
94583-1338
US

IV. Provider business mailing address

206 N JACKSON ST STE 202
GLENDALE CA
91206-4330
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax:
Mailing address:
  • Phone:
  • 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: