Provider Demographics
NPI:1437224896
Name:DE GUZMAN, ANGELINE YAGUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELINE
Middle Name:YAGUE
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MR
Other - First Name:ANGELINE
Other - Middle Name:YAGUE
Other - Last Name:DE GUZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:301 EAST COOK STREET
Mailing Address - Street 2:SUITE K
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-922-2477
Mailing Address - Fax:805-922-2669
Practice Address - Street 1:301 EAST COOK STREET
Practice Address - Street 2:SUITE K
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-922-2477
Practice Address - Fax:805-922-2669
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA502992084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE90984Medicare UPIN