Healthcare Provider Details

I. General information

NPI: 1053263616
Provider Name (Legal Business Name): ANGEL GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20254 MIDLAND BLVD
CALDWELL ID
83605-7902
US

IV. Provider business mailing address

20254 MIDLAND BLVD
CALDWELL ID
83605-7902
US

V. Phone/Fax

Practice location:
  • Phone: 208-440-5217
  • Fax:
Mailing address:
  • Phone: 208-440-5217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: