Healthcare Provider Details

I. General information

NPI: 1386417632
Provider Name (Legal Business Name): MRS. ANGELICA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 03/08/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MARKET ST NW APT 2402
ALBUQUERQUE NM
87120-4164
US

IV. Provider business mailing address

221 53RD ST SW
ALBUQUERQUE NM
87105-2507
US

V. Phone/Fax

Practice location:
  • Phone: 505-267-2242
  • Fax:
Mailing address:
  • Phone: 505-267-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: