Healthcare Provider Details

I. General information

NPI: 1730675513
Provider Name (Legal Business Name): DANIEL GUZMAN RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 VACA VALLEY PKWY STE 900
VACAVILLE CA
95688-9419
US

IV. Provider business mailing address

2401 WATERMAN BLVD STE 4A-208
FAIRFIELD CA
94534-1800
US

V. Phone/Fax

Practice location:
  • Phone: 707-317-5584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-58886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: