Healthcare Provider Details

I. General information

NPI: 1124693528
Provider Name (Legal Business Name): NATALIA GUADALUPE GUZMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD STE 605
LOS ANGELES CA
90025-6842
US

IV. Provider business mailing address

8344 N COOPER PL
WINNETKA CA
91306-1552
US

V. Phone/Fax

Practice location:
  • Phone: 424-644-2400
  • Fax:
Mailing address:
  • Phone: 818-209-6676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number95030145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: