Healthcare Provider Details

I. General information

NPI: 1760698757
Provider Name (Legal Business Name): GUADALUPE GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 SAN FELIPE RD
HOLLISTER CA
95023-2800
US

IV. Provider business mailing address

16150 CHURCH ST
MORGAN HILL CA
95037-5415
US

V. Phone/Fax

Practice location:
  • Phone: 831-636-4020
  • Fax: 831-636-4025
Mailing address:
  • Phone: 408-605-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: