Healthcare Provider Details

I. General information

NPI: 1659263275
Provider Name (Legal Business Name): BENJAMIN ERNESTO GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7248 JOSHUA LN
YUCCA VALLEY CA
92284-2923
US

IV. Provider business mailing address

7248 JOSHUA LN
YUCCA VALLEY CA
92284-2923
US

V. Phone/Fax

Practice location:
  • Phone: 951-394-1261
  • Fax:
Mailing address:
  • Phone: 951-394-1261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: