Provider Demographics
NPI:1679765598
Name:HECTOR BOBBY GUZMAN
Entity type:Organization
Organization Name:HECTOR BOBBY GUZMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:BOBBY
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:509-544-0911
Mailing Address - Street 1:1307 W COURT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-4104
Mailing Address - Country:US
Mailing Address - Phone:509-544-0911
Mailing Address - Fax:509-544-0922
Practice Address - Street 1:1307 W COURT ST STE 2
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-4104
Practice Address - Country:US
Practice Address - Phone:509-544-0911
Practice Address - Fax:509-544-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001957261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder