Healthcare Provider Details

I. General information

NPI: 1740062918
Provider Name (Legal Business Name): JOSEPH ROLAND GUZMAN KISS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11721 TELEGRAPH RD STE A
SANTA FE SPRINGS CA
90670-6835
US

IV. Provider business mailing address

11721 TELEGRAPH RD STE A
SANTA FE SPRINGS CA
90670-6835
US

V. Phone/Fax

Practice location:
  • Phone: 562-949-8455
  • Fax:
Mailing address:
  • Phone: 562-949-8455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT142613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: