Provider Demographics
NPI:1144240417
Name:GUZMAN, RENATO FRANCISCO (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATO
Middle Name:FRANCISCO
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6601 WHITE FEATHER RD
Mailing Address - Street 2:SUITE A4
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-6607
Mailing Address - Country:US
Mailing Address - Phone:760-366-6128
Mailing Address - Fax:760-366-6130
Practice Address - Street 1:6601 WHITE FEATHER RD
Practice Address - Street 2:SUITE A4
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252-6607
Practice Address - Country:US
Practice Address - Phone:760-366-6128
Practice Address - Fax:760-366-6130
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24088208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A240880Medicaid
A23813Medicare UPIN
CA00A240880Medicaid