MEDICARE: DR. ERNEST V. DE GUZMAN M.D.

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	2084P0800X	Psychiatry Physician	A95424	CA

General Provider Information

NPI Number	:	1801914544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST V. DE GUZMAN M.D.

Provider Business Mailing Address
First Line	:	6973 LINDA VISTA ROAD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-6342
Country	:	US
Telephone Number	:	858-279-9676
Fax Number	:	858-279-0377

Provider Business Practice Location Address
First Line	:	6973 LINDA VISTA ROAD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-6342
Country	:	US
Telephone Number	:	858-279-9676
Fax Number	:	858-279-0377

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	09/19/2014

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