=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255671566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISAIAS DE GUZMAN PAJA JR. MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2013
-----------------------------------------------------
Last Update Date | 04/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2491 PACIFIC AVE STE 3
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90806-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-989-1322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2491 PACIFIC AVE STE 3
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90806-2900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-989-1322
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | MRS. SUSAN MANABO
-----------------------------------------------------
Credential | N.P
-----------------------------------------------------
Telephone | 562-989-1322
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | A065363
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------