Provider Demographics
NPI:1225121924
Name:DE GUZMAN, JONATHAN R (PA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:R
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:SUITE 241
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1200
Mailing Address - Country:US
Mailing Address - Phone:818-361-0136
Mailing Address - Fax:818-365-1259
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:SUITE 241
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1200
Practice Address - Country:US
Practice Address - Phone:818-361-0136
Practice Address - Fax:818-361-0136
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY011095363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DI628ZMedicare PIN