Healthcare Provider Details

I. General information

NPI: 1356900138
Provider Name (Legal Business Name): KRISTINE ELIZABETH GUZMAN-HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 01/13/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 FAIR OAKS AVE STE 300
SOUTH PASADENA CA
91030-5805
US

IV. Provider business mailing address

10582 STERN AVE
GARDEN GROVE CA
92843-5142
US

V. Phone/Fax

Practice location:
  • Phone: 626-441-4221
  • Fax:
Mailing address:
  • Phone: 714-343-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: