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General NPI Number Information
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NPI Number | 1699069229
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Entity Type | Organization
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Legal Business Name | LANI DE GUZMAN
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 1130 CAMPBELL ST 110
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City | GLENDALE
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State | CA
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Zip | 91207-1674
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Country | US
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Telephone | 213-393-2792
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Fax | 213-406-8014
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Provider Business Mailing Address
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Address Line | 1130 N. CAMPBELL ST 110
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City | GLENDALE
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State | CA
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Zip | 91207-1674
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Country | US
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Telephone | 213-393-2792
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Fax | 213-406-8014
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | LANI DE GUZMAN
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Credential |
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Telephone | 213-393-2792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 200415-0002-7
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License Number State | CA
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