Healthcare Provider Details

I. General information

NPI: 1194208744
Provider Name (Legal Business Name): ASHLEY BRIGETTE GUZMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 12/06/2021
Certification Date: 06/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

IV. Provider business mailing address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax: 909-985-2329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: