Healthcare Provider Details

I. General information

NPI: 1083809537
Provider Name (Legal Business Name): OLGA LYDIA GUIJON M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 09/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 PINE AVE
LONG BEACH CA
90813-3118
US

IV. Provider business mailing address

455 S MAIN ST
ORANGE CA
92868-3835
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0400
  • Fax: 562-933-0487
Mailing address:
  • Phone: 714-532-7571
  • Fax: 714-532-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA55616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: