Healthcare Provider Details

I. General information

NPI: 1063172286
Provider Name (Legal Business Name): MONICA PAOLA GUZMAN-CRESPO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 E FLORIDA AVE
HEMET CA
92543-4511
US

IV. Provider business mailing address

1030 E FLORIDA AVE
HEMET CA
92543-4511
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax: 360-462-2743
Mailing address:
  • Phone: 833-867-4642
  • Fax: 360-462-2743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: