Healthcare Provider Details

I. General information

NPI: 1275895732
Provider Name (Legal Business Name): SIOMARA MAGALY GUZMAN VASQUEZ LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13286 CRANSTON AVE
SYLMAR CA
91342-3215
US

IV. Provider business mailing address

176 HOLSTON DR
LANCASTER CA
93535-4531
US

V. Phone/Fax

Practice location:
  • Phone: 213-507-2166
  • Fax: 844-590-1562
Mailing address:
  • Phone: 213-507-2166
  • Fax: 844-590-1562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119204
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number115058
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: