Provider Demographics
NPI:1083809537
Name:GUIJON, OLGA LYDIA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:LYDIA
Last Name:GUIJON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3835
Mailing Address - Country:US
Mailing Address - Phone:714-532-7571
Mailing Address - Fax:714-532-7550
Practice Address - Street 1:1057 PINE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3118
Practice Address - Country:US
Practice Address - Phone:562-933-0400
Practice Address - Fax:562-933-0487
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55616208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA055616OtherPROFESSIONAL LICENSE