Provider Demographics
NPI:1053896605
Name:VISTE GUZMAN, ROXANA ELIZABETH
Entity type:Individual
Prefix:
First Name:ROXANA
Middle Name:ELIZABETH
Last Name:VISTE 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 1:112 CHILDRENS CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-6558
Mailing Address - Country:US
Mailing Address - Phone:707-565-4322
Mailing Address - Fax:
Practice Address - Street 1:112 CHILDRENS CIR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-6558
Practice Address - Country:US
Practice Address - Phone:707-565-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-29
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician