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General NPI Number Information
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NPI Number | 1952810251
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Entity Type | Organization
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Legal Business Name | EARL ANDREW B. DE GUZMAN MD, APC.
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Dates
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Enumeration Date | 09/29/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 317 14TH ST STE A
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City | DEL MAR
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State | CA
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Zip | 92014-2554
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Country | US
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Telephone | 510-676-2034
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Fax |
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Provider Business Mailing Address
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Address Line | 317 14TH ST STE A
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City | DEL MAR
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State | CA
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Zip | 92014-2554
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | EARL ANDREW BALAYAN DE GUZMAN
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Credential | MD
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Telephone | 510-676-2034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | A132370
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A132370
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License Number State | CA
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