Healthcare Provider Details

I. General information

NPI: 1871081604
Provider Name (Legal Business Name): NICOLAS GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR BLDG F
MODESTO CA
95350-6131
US

IV. Provider business mailing address

800 SCENIC DR BLDG F
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-6150
  • Fax:
Mailing address:
  • Phone: 209-525-6150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberR1251560517
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: