Healthcare Provider Details

I. General information

NPI: 1033778576
Provider Name (Legal Business Name): CATHRYN DE GUZMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2019
Last Update Date: 07/14/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91275 66TH ST SUITE 500
MECCA CA
92254-1251
US

IV. Provider business mailing address

91275 66TH AVE SUITE 500
MECCA CA
92254
US

V. Phone/Fax

Practice location:
  • Phone: 760-396-1249
  • Fax: 760-396-1253
Mailing address:
  • Phone: 760-396-1249
  • Fax: 760-396-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number56870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: