MEDICARE: MR. GUY D DENTON JR. RD

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	133V00000X	Registered Dietitian	86081613	CA

General Provider Information

NPI Number	:	1942827167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GUY D DENTON JR. RD

Provider Business Mailing Address
First Line	:	1739 N STANTON PL APT 7
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-7917
Country	:	US
Telephone Number	:	310-926-5828
Fax Number	:

Provider Business Practice Location Address
First Line	:	1739 N STANTON PL APT 7
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-7917
Country	:	US
Telephone Number	:	310-926-5828
Fax Number	:

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

Provider Enumeration Date	:	07/03/2020
Last Update Date	:	07/03/2020

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