Healthcare Provider Details

I. General information

NPI: 1215231352
Provider Name (Legal Business Name): ADAN GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2011
Last Update Date: 01/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 KRESGE LN
SPARKS NV
89431-6435
US

IV. Provider business mailing address

2495 CANNAN ST
RENO NV
89512-2002
US

V. Phone/Fax

Practice location:
  • Phone: 775-359-9200
  • Fax:
Mailing address:
  • Phone: 775-354-9215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: