Healthcare Provider Details

I. General information

NPI: 1386675452
Provider Name (Legal Business Name): ROSALIE A DE GUZMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 S MAIN ST STE 100
CORONA CA
92882-3421
US

IV. Provider business mailing address

823 S MAIN ST STE 100
CORONA CA
92882-3421
US

V. Phone/Fax

Practice location:
  • Phone: 951-270-0067
  • Fax:
Mailing address:
  • Phone: 951-270-0067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA39804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: