Healthcare Provider Details

I. General information

NPI: 1861279556
Provider Name (Legal Business Name): LUCIA GUADALUPE GUZMAN-MENDOZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DRAKE GUZMAN-MENDOZA DRAKE GUZMAN-MENDOZA

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 S FIFE ST STE 301
TACOMA WA
98409-7309
US

IV. Provider business mailing address

5410 N 44TH ST
TACOMA WA
98407-3799
US

V. Phone/Fax

Practice location:
  • Phone: 253-589-5334
  • Fax: 253-584-0770
Mailing address:
  • Phone: 253-759-9544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: