Healthcare Provider Details

I. General information

NPI: 1841767910
Provider Name (Legal Business Name): CAROLINA GUZMAN LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 10/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 MARTIN LUTHER KING JR BLVD
LYNWOOD CA
90262-3625
US

IV. Provider business mailing address

5637 CECILIA ST APT D
BELL GARDENS CA
90201-6151
US

V. Phone/Fax

Practice location:
  • Phone: 310-632-0415
  • Fax:
Mailing address:
  • Phone: 562-296-3319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number698599
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: