Healthcare Provider Details

I. General information

NPI: 1306259114
Provider Name (Legal Business Name): VICTOR GUHAROY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 N RIVERSIDE AVE
RIALTO CA
92377-4696
US

IV. Provider business mailing address

2608 SCHOOL OF MEDICINE EDUCATION BUILDING
RIVERSIDE CA
92521-0001
US

V. Phone/Fax

Practice location:
  • Phone: 909-644-4033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA139954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: