MEDICARE: GAYNELLE DE GUZMAN

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	95011460	CA

General Provider Information

NPI Number	:	1609337625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYNELLE DE GUZMAN

Provider Business Mailing Address
First Line	:	4240 HIGHLAND AVE
Second Line	:
City	:	HIGHLAND
State	:	CA
Zip	:	92346-2764
Country	:	US
Telephone Number	:	909-864-4700
Fax Number	:	909-864-4300

Provider Business Practice Location Address
First Line	:	4240 HIGHLAND AVE
Second Line	:
City	:	HIGHLAND
State	:	CA
Zip	:	92346-2764
Country	:	US
Telephone Number	:	909-864-4700
Fax Number	:	909-864-4300

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

Provider Enumeration Date	:	03/31/2019
Last Update Date	:	03/24/2026

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Directions to “ GAYNELLE DE GUZMAN ” Practice Location

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