Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003319716 |
---|---|
Provider Name | Mrs. Ashley Guzman |
First Address | San Bernardino, CA 92405-3919 |
Second Address | San Bernardino, CA 92405-3919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2018 |
Last Update Date | 09/03/2018 |