Healthcare Provider Details

I. General information

NPI: 1336699370
Provider Name (Legal Business Name): ISAIAS DE GUZMAN PAJA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WILSHIRE BLVD
LOS ANGELES CA
90057-3602
US

IV. Provider business mailing address

1800 WILSHIRE BLVD
LOS ANGELES CA
90057-3602
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-9934
  • Fax: 213-484-9939
Mailing address:
  • Phone: 213-484-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number23064
License Number StateCA

VIII. Authorized Official

Name: MS. ARDIENTES CATHAINA TOLENTINO
Title or Position: NURSE PRACTITIONER
Credential: NP-C
Phone: 714-883-0094