Provider Demographics
NPI:1114556040
Name:GUZMAN, IRISHA
Entity Type:Individual
Prefix:
First Name:IRISHA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10462 HIGHDALE ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-4123
Mailing Address - Country:US
Mailing Address - Phone:562-316-6629
Mailing Address - Fax:
Practice Address - Street 1:10462 HIGHDALE ST
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4123
Practice Address - Country:US
Practice Address - Phone:562-316-6629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95013590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF01190109OtherAANP FNP NUMBER
CANP95013590OtherCA NP PROVIDER NUMBER
CA95013590OtherCA FURNISHING NUMBER