Healthcare Provider Details

I. General information

NPI: 1487169850
Provider Name (Legal Business Name): ERIKA MILENA GUZMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 LUZ DE SOL DR SE
RIO RANCHO NM
87124-8727
US

IV. Provider business mailing address

1509 LUZ DE SOL DR SE
RIO RANCHO NM
87124-8727
US

V. Phone/Fax

Practice location:
  • Phone: 719-321-5760
  • Fax:
Mailing address:
  • Phone: 719-321-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number00004646
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: