Healthcare Provider Details

I. General information

NPI: 1952810251
Provider Name (Legal Business Name): EARL ANDREW B. DE GUZMAN MD, APC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 14TH ST STE A
DEL MAR CA
92014-2554
US

IV. Provider business mailing address

317 14TH ST STE A
DEL MAR CA
92014-2554
US

V. Phone/Fax

Practice location:
  • Phone: 510-676-2034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberA132370
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA132370
License Number StateCA

VIII. Authorized Official

Name: EARL ANDREW BALAYAN DE GUZMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 510-676-2034