Healthcare Provider Details

I. General information

NPI: 1588590699
Provider Name (Legal Business Name): JEANETTE GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 15TH ST # C
MERCED CA
95341-6217
US

IV. Provider business mailing address

750 WOODSIDE LN
ATWATER CA
95301-4849
US

V. Phone/Fax

Practice location:
  • Phone: 209-626-4420
  • Fax: 209-722-7648
Mailing address:
  • Phone: 209-631-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: