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General NPI Number Information
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NPI Number | 1174703904
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Entity Type | Organization
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Legal Business Name | ERNEST V. DE GUZMAN, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 3010 1ST AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-5816
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Country | US
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Telephone | 619-295-2189
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Fax | 619-295-2362
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Provider Business Mailing Address
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Address Line | 3010 1ST AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-5816
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Country | US
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Telephone | 619-295-2189
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Fax | 619-295-2362
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERNEST VISPERAS DE GUZMAN
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Credential | M.D.
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Telephone | 619-295-2189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | A95424
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License Number State | CA
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