Provider Demographics
NPI:1679324305
Name:GUZMAN, RAFAEL (RBT)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16600 SHERMAN WAY STE 175
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3847
Mailing Address - Country:US
Mailing Address - Phone:818-991-7722
Mailing Address - Fax:818-991-7722
Practice Address - Street 1:16600 SHERMAN WAY STE 105
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-3876
Practice Address - Country:US
Practice Address - Phone:818-991-7722
Practice Address - Fax:818-991-7722
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-23-278931106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician