Healthcare Provider Details

I. General information

NPI: 1568048189
Provider Name (Legal Business Name): SYDNEY GUZMAN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 E HAMPTON ST
STOCKTON CA
95204-5519
US

IV. Provider business mailing address

705 E LINDSAY ST APT 13
STOCKTON CA
95202-2606
US

V. Phone/Fax

Practice location:
  • Phone: 237-998-6933
  • Fax:
Mailing address:
  • Phone: 323-799-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21822
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: