Healthcare Provider Details

I. General information

NPI: 1003162025
Provider Name (Legal Business Name): ANTHONY WILLIAM MCGUIRE RN, PHD, ACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 E 17TH ST
LONG BEACH CA
90804-2001
US

IV. Provider business mailing address

3640 E 17TH ST
LONG BEACH CA
90804-2001
US

V. Phone/Fax

Practice location:
  • Phone: 562-209-2861
  • Fax:
Mailing address:
  • Phone: 562-209-2861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number9998
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number436601
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: