Healthcare Provider Details

I. General information

NPI: 1336135169
Provider Name (Legal Business Name): RICHARD A GUZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6485 DAY ST SUITE 206
RIVERSIDE CA
92507-0930
US

IV. Provider business mailing address

6485 DAY ST SUITE 206
RIVERSIDE CA
92507-0930
US

V. Phone/Fax

Practice location:
  • Phone: 951-697-7824
  • Fax: 951-697-6461
Mailing address:
  • Phone: 951-697-7824
  • Fax: 951-697-6461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG63734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: