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General NPI Number Information
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NPI Number | 1457677189
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Entity Type | Individual
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Provider Name | ROBERTO JOSE GUADAMUZ D.C.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 05/13/2010
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Provider Practice Location Address
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Address Line | 1695 S SAN JACINTO AVE STE. O
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City | SAN JACINTO
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State | CA
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Zip | 92583-5103
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Country | US
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Telephone | 951-654-5900
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Fax | 951-654-5933
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Provider Business Mailing Address
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Address Line | 1695 S SAN JACINTO AVE STE. O
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City | SAN JACINTO
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State | CA
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Zip | 92583-5103
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Country | US
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Telephone | 951-654-5900
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Fax | 951-654-5933
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 27604
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License Number State | CA
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