Healthcare Provider Details

I. General information

NPI: 1902866049
Provider Name (Legal Business Name): GEORGE D GUIDO III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 S BASCOM AVE STE 110
CAMPBELL CA
95008-5541
US

IV. Provider business mailing address

2542 S BASCOM AVE STE 110
CAMPBELL CA
95008-5541
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-3403
  • Fax: 408-559-3158
Mailing address:
  • Phone: 408-559-3403
  • Fax: 408-559-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51518
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number51518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: