Healthcare Provider Details

I. General information

NPI: 1184653628
Provider Name (Legal Business Name): JULIO V GUZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 BEVERLY BLVD 212
LOS ANGELES CA
90004-4479
US

IV. Provider business mailing address

4214 BEVERLY BLVD 212
LOS ANGELES CA
90004-4479
US

V. Phone/Fax

Practice location:
  • Phone: 213-385-9912
  • Fax: 213-385-9915
Mailing address:
  • Phone: 213-385-9912
  • Fax: 213-385-9915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA066211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: