Provider Demographics
NPI:1124592589
Name:AMI, DENNIS ACE DE GUZMAN (LVN)
Entity Type:Individual
Prefix:
First Name:DENNIS ACE
Middle Name:DE GUZMAN
Last Name:AMI
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 1/2 S HOBART BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-5208
Mailing Address - Country:US
Mailing Address - Phone:323-898-9131
Mailing Address - Fax:
Practice Address - Street 1:248 1/2 S HOBART BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-5208
Practice Address - Country:US
Practice Address - Phone:323-898-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA277234164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse