Provider Demographics
NPI:1972477347
Name:DE GUZMAN, PATRICK RENZ
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:RENZ
Last Name:DE 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 1:3200 INGLEWOOD AVE S APT 320
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4655
Mailing Address - Country:US
Mailing Address - Phone:818-294-6396
Mailing Address - Fax:
Practice Address - Street 1:7550 FRANCE AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5624
Practice Address - Country:US
Practice Address - Phone:952-955-4057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician