MEDICARE: ISAIAS DE GUZMAN PAJA JR. MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	A065363	CA

General Provider Information

NPI Number	:	1255671566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISAIAS DE GUZMAN PAJA JR. MD INC

Provider Business Mailing Address
First Line	:	2491 PACIFIC AVE STE 3
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2900
Country	:	US
Telephone Number	:	562-989-1322
Fax Number	:

Provider Business Practice Location Address
First Line	:	2491 PACIFIC AVE STE 3
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2900
Country	:	US
Telephone Number	:	562-989-1322
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MRS. SUSAN MANABO
Credential	:	N.P
Telephone Number	:	562-989-1322

Provider Enumeration Date	:	02/22/2013
Last Update Date	:	04/05/2013

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