Healthcare Provider Details

I. General information

NPI: 1255824298
Provider Name (Legal Business Name): PERLA GUZMAN CAODC 7802
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MORRISON AVE STE B
SANTA MARIA CA
93458-6124
US

IV. Provider business mailing address

2029 TANGLEWOOD DR
SANTA MARIA CA
93455-2855
US

V. Phone/Fax

Practice location:
  • Phone: 805-347-3338
  • Fax: 806-672-9974
Mailing address:
  • Phone: 805-406-5137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number7802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: