Healthcare Provider Details

I. General information

NPI: 1316662091
Provider Name (Legal Business Name): EDDIE GUZMAN AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11360 183RD ST
CERRITOS CA
90703-5419
US

IV. Provider business mailing address

629 W ELM AVE
FULLERTON CA
92832-2707
US

V. Phone/Fax

Practice location:
  • Phone: 562-809-2167
  • Fax:
Mailing address:
  • Phone: 714-681-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number3743
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: