Healthcare Provider Details

I. General information

NPI: 1285168831
Provider Name (Legal Business Name): JUNNEL GUIDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HEARTHSTONE DR
AMERICAN CANYON CA
94503-3144
US

IV. Provider business mailing address

115 HEARTHSTONE DR
AMERICAN CANYON CA
94503-3144
US

V. Phone/Fax

Practice location:
  • Phone: 707-853-6583
  • Fax:
Mailing address:
  • Phone: 707-853-6583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPT28397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: