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General NPI Number Information
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NPI Number | 1497401426
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Entity Type | Organization
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Legal Business Name | MEDICUS PROVIDER SERVICES INC
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 12/29/2022
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Provider Practice Location Address
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Address Line | 29490 KRISTINE CT
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City | SANTA CLARITA
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State | CA
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Zip | 91387-1404
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Country | US
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Telephone | 818-212-9260
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Fax |
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Provider Business Mailing Address
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Address Line | 24808 SAND WEDGE LN
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City | VALENCIA
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State | CA
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Zip | 91355-2315
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Country | US
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Telephone | 818-212-9260
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | VICTOR T DE GUZMAN
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Credential | NP
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Telephone | 818-212-9260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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