Provider Demographics
NPI:1326298530
Name:GUZMAN, STACY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 S CENTRAL VALLEY HWY
Mailing Address - Street 2:P.O. BOX 1060
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2790
Mailing Address - Country:US
Mailing Address - Phone:661-459-1900
Mailing Address - Fax:661-459-1974
Practice Address - Street 1:277 E. FRONT STEET
Practice Address - Street 2:
Practice Address - City:BUTTONWILLOW
Practice Address - State:CA
Practice Address - Zip Code:93206-0917
Practice Address - Country:US
Practice Address - Phone:661-764-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant