Healthcare Provider Details

I. General information

NPI: 1396755542
Provider Name (Legal Business Name): JOCELYN B DE GUZMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 ERRECART BLVD
ELKO NV
89801-8334
US

IV. Provider business mailing address

1993 ERRECART BLVD
ELKO NV
89801-8334
US

V. Phone/Fax

Practice location:
  • Phone: 775-753-1049
  • Fax: 775-777-8494
Mailing address:
  • Phone: 775-753-1049
  • Fax: 775-777-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11191
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number11191
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: