Healthcare Provider Details

I. General information

NPI: 1417262916
Provider Name (Legal Business Name): LIDIA Y GUZMAN BASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 TEXAS ST STE. 203
SAN DIEGO CA
92108-3721
US

IV. Provider business mailing address

2908 ALTA DR
NATIONAL CITY CA
91950-7807
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-0727
  • Fax:
Mailing address:
  • Phone: 619-988-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: