MEDICARE: MARICELA. LIZZETTE GUZMAN NP

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	363LF0000X	Family Nurse Practitioner	95018507	CA

General Provider Information

NPI Number	:	1437811528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARICELA. LIZZETTE GUZMAN NP

Provider Business Mailing Address
First Line	:	1072 VIA BARRANCA
Second Line	:
City	:	CALEXICO
State	:	CA
Zip	:	92231-4515
Country	:	US
Telephone Number	:	760-235-9142
Fax Number	:

Provider Business Practice Location Address
First Line	:	1671 W MAIN ST STE D
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-5420
Country	:	US
Telephone Number	:	760-352-3366
Fax Number	:	760-352-3377

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2021
Last Update Date	:	10/06/2021

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