Provider Demographics
NPI:1538938048
Name:ESTRADA GUZMAN, ANGEL MARTIN
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARTIN
Last Name:ESTRADA GUZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18437 COLLINS STREET APT 36
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-447-2431
Mailing Address - Fax:
Practice Address - Street 1:5416 E OLETA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4428
Practice Address - Country:US
Practice Address - Phone:818-447-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC236Medicaid