Healthcare Provider Details

I. General information

NPI: 1316172273
Provider Name (Legal Business Name): ANA YANSI GUZMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 W MAIN ST STE 101
TUSTIN CA
92780-7712
US

IV. Provider business mailing address

PO BOX 2171
COSTA MESA CA
92628-2171
US

V. Phone/Fax

Practice location:
  • Phone: 714-989-9955
  • Fax:
Mailing address:
  • Phone: 714-369-3563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC53110
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number58669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: