Provider Demographics
NPI:1063216950
Name:RIVERA GUZMAN, HENRY G SR (CMT)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:G
Last Name:RIVERA GUZMAN
Suffix:SR
Gender:
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 WESTBOURNE DR APT 105
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4125
Mailing Address - Country:US
Mailing Address - Phone:310-270-2631
Mailing Address - Fax:
Practice Address - Street 1:1200 ALTA LOMA RD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2404
Practice Address - Country:US
Practice Address - Phone:310-927-3097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97266225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist