Healthcare Provider Details

I. General information

NPI: 1518704287
Provider Name (Legal Business Name): SAMANTHA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6226 HAVILAND AVE
WHITTIER CA
90601-3735
US

IV. Provider business mailing address

1315 BARTON ROAD SUITE A,B,C
WHITTIER CA
90605
US

V. Phone/Fax

Practice location:
  • Phone: 562-378-9182
  • Fax:
Mailing address:
  • Phone: 949-796-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: