Healthcare Provider Details

I. General information

NPI: 1073295309
Provider Name (Legal Business Name): MIRIAN ESTELA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/04/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 SKYWAY DR STE 104
SANTA MARIA CA
93455-1133
US

IV. Provider business mailing address

300 45TH ST S
FARGO ND
58103-1189
US

V. Phone/Fax

Practice location:
  • Phone: 805-621-4252
  • Fax:
Mailing address:
  • Phone: 805-621-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number111889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: