Provider Demographics
NPI:1154819548
Name:PLACENSIO-GUZMAN, MARIBEL (NP)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:PLACENSIO-GUZMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARIBEL
Other - Middle Name:
Other - Last Name:PLASENCIO-GUZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:12550 HESPERIA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5873
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12550 HESPERIA RD STE 100
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:760-241-6666
Practice Address - Fax:760-947-5619
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily