Healthcare Provider Details

I. General information

NPI: 1033590989
Provider Name (Legal Business Name): PATRICIA AYALA-GUZMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN ST STE 650
SANTA ANA CA
92701-3613
US

IV. Provider business mailing address

821 S BROADWAY
SANTA ANA CA
92701-5645
US

V. Phone/Fax

Practice location:
  • Phone: 714-824-8140
  • Fax: 714-824-8141
Mailing address:
  • Phone: 714-356-6528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. PATRICIA AYALA-GUZMAN
Title or Position: UNLICENSED MENTAL HEALTH TRAINEE
Credential:
Phone: 714-356-6528