Healthcare Provider Details

I. General information

NPI: 1992858864
Provider Name (Legal Business Name): JOHN GUZMAN PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

IV. Provider business mailing address

556-31ST AVE.
SAN MATEO CA
94403
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2351
  • Fax:
Mailing address:
  • Phone: 650-571-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY11439
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: