Healthcare Provider Details

I. General information

NPI: 1326275587
Provider Name (Legal Business Name): OLIVIA GUZMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 MAIN ST STE 3
WATSONVILLE CA
95076-3760
US

IV. Provider business mailing address

5 MONTEREY VISTA CT
WATSONVILLE CA
95076-6605
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-0551
  • Fax: 831-728-3279
Mailing address:
  • Phone: 831-247-4190
  • Fax: 831-728-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberCA15046
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: