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General NPI Number Information
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NPI Number | 1679765598
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Entity Type | Organization
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Legal Business Name | HECTOR BOBBY GUZMAN
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 06/13/2008
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Provider Practice Location Address
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Address Line | 1307 W COURT ST STE 2
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City | PASCO
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State | WA
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Zip | 99301-4104
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Country | US
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Telephone | 509-544-0911
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Fax | 509-544-0922
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Provider Business Mailing Address
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Address Line | 1307 W COURT ST STE 2
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City | PASCO
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State | WA
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Zip | 99301-4104
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Country | US
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Telephone | 509-544-0911
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Fax | 509-544-0922
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. HECTOR BOBBY GUZMAN
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Credential | CDP
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Telephone | 509-544-0911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | CP00001957
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License Number State | WA
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