Provider Demographics
NPI:1336135169
Name:GUZMAN, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
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 1:6485 DAY ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0930
Mailing Address - Country:US
Mailing Address - Phone:951-697-7824
Mailing Address - Fax:951-697-6461
Practice Address - Street 1:6485 DAY ST
Practice Address - Street 2:SUITE 206
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0930
Practice Address - Country:US
Practice Address - Phone:951-697-7824
Practice Address - Fax:951-697-6461
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG63734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G637340Medicaid
CA00G637340Medicaid
F13371Medicare UPIN