Healthcare Provider Details

I. General information

NPI: 1689508376
Provider Name (Legal Business Name): JESSICA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 PLAZA DEL AMO
TORRANCE CA
90501-3420
US

IV. Provider business mailing address

2413 1/2 FISK LN
REDONDO BEACH CA
90278-5103
US

V. Phone/Fax

Practice location:
  • Phone: 310-972-6100
  • Fax:
Mailing address:
  • Phone: 619-948-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number21647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: