Healthcare Provider Details

I. General information

NPI: 1467162925
Provider Name (Legal Business Name): MARIA MELISA MALABANAN DE GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2022
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1498 SOUTHGATE AVE # 102
DALY CITY CA
94015-4015
US

IV. Provider business mailing address

1498 SOUTHGATE AVE # 102
DALY CITY CA
94015-4015
US

V. Phone/Fax

Practice location:
  • Phone: 650-755-4490
  • Fax:
Mailing address:
  • Phone: 650-755-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95024577
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number687538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: