MEDICARE: MARY GUIRGUIS

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	363A00000X	Physician Assistant	52152	CA
2	363AM0700X	Medical Physician Assistant	52152	CA

General Provider Information

NPI Number	:	1447648357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GUIRGUIS

Provider Business Mailing Address
First Line	:	3202 WATERMARKE PL
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-5616
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6920 MIRAMAR RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2632
Country	:	US
Telephone Number	:	858-530-4856
Fax Number	:

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

Provider Enumeration Date	:	12/30/2014
Last Update Date	:	12/30/2014

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Directions to “ MARY GUIRGUIS ” Practice Location

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