Provider Demographics
NPI:1912755299
Name:DE GUZMAN, GLORJES CAVEN
Entity type:Individual
Prefix:
First Name:GLORJES CAVEN
Middle Name:
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 N CAPITOL AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1310
Mailing Address - Country:US
Mailing Address - Phone:408-802-1145
Mailing Address - Fax:
Practice Address - Street 1:819 N CAPITOL AVE APT 4
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1310
Practice Address - Country:US
Practice Address - Phone:408-802-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health