Healthcare Provider Details

I. General information

NPI: 1336617315
Provider Name (Legal Business Name): GERARDO C GUZMAN CP, CTPO, CFO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6190 FAIRMOUNT AVE STE A
SAN DIEGO CA
92120-3428
US

IV. Provider business mailing address

6190 FAIRMOUNT AVE STE A
SAN DIEGO CA
92120-3428
US

V. Phone/Fax

Practice location:
  • Phone: 619-285-5040
  • Fax: 619-285-5045
Mailing address:
  • Phone: 619-285-5040
  • Fax: 619-285-5045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: