Provider Demographics
NPI:1255671566
Name:ISAIAS DE GUZMAN PAJA JR. MD INC
Entity Type:Organization
Organization Name:ISAIAS DE GUZMAN PAJA JR. MD INC
Other - Org Name:OLYMPIC FAMILIA CLINICA INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANABO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:562-989-1322
Mailing Address - Street 1:2491 PACIFIC AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2900
Mailing Address - Country:US
Mailing Address - Phone:562-989-1322
Mailing Address - Fax:
Practice Address - Street 1:2491 PACIFIC AVE STE 3
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2900
Practice Address - Country:US
Practice Address - Phone:562-989-1322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISAIAS DE GUZMAN PAJA JR. MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-22
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA065363261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA65363Medicare UPIN