Healthcare Provider Details

I. General information

NPI: 1396478442
Provider Name (Legal Business Name): GALEN GUZMAN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HERNDON RD
CERES CA
95307-4421
US

IV. Provider business mailing address

1400 GENEVIEVE WAY
CERES CA
95307-9300
US

V. Phone/Fax

Practice location:
  • Phone: 209-589-1500
  • Fax:
Mailing address:
  • Phone: 209-918-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95021381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: