Healthcare Provider Details

I. General information

NPI: 1013110717
Provider Name (Legal Business Name): AMY KATHERINE GUZIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR # MC8466
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

WAKE FOREST UNIVERSITY HEALTH SCIENCE MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-7760
  • Fax: 619-543-7771
Mailing address:
  • Phone: 336-713-4947
  • Fax: 336-716-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2013-01837
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA117020
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA117020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: