Healthcare Provider Details

I. General information

NPI: 1790586899
Provider Name (Legal Business Name): LETICIA GUZMAN-MARISCAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1766 FOWLER ST STE A
RICHLAND WA
99352-4843
US

IV. Provider business mailing address

1766 FOWLER ST STE A
RICHLAND WA
99352-4843
US

V. Phone/Fax

Practice location:
  • Phone: 509-735-9355
  • Fax: 509-222-1511
Mailing address:
  • Phone: 509-735-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61630273
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: