Healthcare Provider Details

I. General information

NPI: 1891984670
Provider Name (Legal Business Name): EJ GUZMAN, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11514 ROSECRANS AVE
NORWALK CA
90650-3802
US

IV. Provider business mailing address

11514 ROSECRANS AVE
NORWALK CA
90650-3802
US

V. Phone/Fax

Practice location:
  • Phone: 562-929-9999
  • Fax: 562-929-0891
Mailing address:
  • Phone: 562-929-9999
  • Fax: 562-929-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberA50344
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA50344
License Number StateCA

VIII. Authorized Official

Name: DR. EDUARDO JOSE GUZMAN
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 562-929-9999