Healthcare Provider Details

I. General information

NPI: 1811336381
Provider Name (Legal Business Name): CYNTHIA EILEEN GUZMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 WEST HIGHWAY 22
SANTO DOMINGO NM
87052
US

IV. Provider business mailing address

85 WEST HIGHWAY 22
SANTO DOMINGO NM
87052
US

V. Phone/Fax

Practice location:
  • Phone: 505-465-3068
  • Fax: 505-465-1178
Mailing address:
  • Phone: 505-465-3068
  • Fax: 505-465-1178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1276
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: