Healthcare Provider Details

I. General information

NPI: 1346640984
Provider Name (Legal Business Name): HUGO GUADIAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 MARENGO ST
LOS ANGELES CA
90033-1319
US

IV. Provider business mailing address

7825 ATLANTIC AVE
CUDAHY CA
90201-5022
US

V. Phone/Fax

Practice location:
  • Phone: 323-987-1030
  • Fax: 323-221-4528
Mailing address:
  • Phone: 323-562-6544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: