Healthcare Provider Details

I. General information

NPI: 1932690666
Provider Name (Legal Business Name): GERMEL DE GUZMAN SAGUN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4237 OLOROSO CIR
MOORPARK CA
93021-2107
US

IV. Provider business mailing address

1550 PACHINO CIR APT G
THOUSAND OAKS CA
91320-6531
US

V. Phone/Fax

Practice location:
  • Phone: 415-481-5515
  • Fax:
Mailing address:
  • Phone: 415-481-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95038026
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95030421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: