Healthcare Provider Details

I. General information

NPI: 1346659075
Provider Name (Legal Business Name): SAGIE DE GUZMAN PHD, A-CNS, ANP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

729 S HOBART BLVD APT 10
LOS ANGELES CA
90005-2839
US

V. Phone/Fax

Practice location:
  • Phone: 310-582-7137
  • Fax:
Mailing address:
  • Phone: 213-268-5414
  • Fax: 213-977-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP95000814
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number4151
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95000814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: