Healthcare Provider Details

I. General information

NPI: 1114413788
Provider Name (Legal Business Name): PAULA MARIE GUZMAN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2018
Last Update Date: 02/27/2022
Certification Date: 02/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 CASTLEGATE LN
REDLANDS CA
92374-1636
US

IV. Provider business mailing address

1955 CASTLEGATE LN
REDLANDS CA
92374-1636
US

V. Phone/Fax

Practice location:
  • Phone: 909-809-6865
  • Fax: 909-793-5987
Mailing address:
  • Phone: 909-809-6865
  • Fax: 909-793-5987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95016004
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number544665
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: