Healthcare Provider Details

I. General information

NPI: 1386058139
Provider Name (Legal Business Name): ERICK APONTE GUZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 02/11/2022
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD BLDG 98
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

1011 RIVERSIDE AVE
ROSEVILLE CA
95678-5134
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7560
  • Fax: 916-561-7566
Mailing address:
  • Phone: 916-759-9756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA161077
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: