Healthcare Provider Details

I. General information

NPI: 1780039339
Provider Name (Legal Business Name): SULEYMA GUADALUPE GUZMAN PICHARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32525 CANYON VISTA RD APT A
CATHEDRAL CITY CA
92234-9306
US

IV. Provider business mailing address

32525 CANYON VISTA RD APT A
CATHEDRAL CITY CA
92234-9306
US

V. Phone/Fax

Practice location:
  • Phone: 760-969-9958
  • Fax:
Mailing address:
  • Phone: 760-969-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: