Provider Demographics
NPI:1467946020
Name:DE GUZMAN, SONIA CAMACHO (FNP)
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:CAMACHO
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 DEL PASO BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-3102
Mailing Address - Country:US
Mailing Address - Phone:916-642-1867
Mailing Address - Fax:
Practice Address - Street 1:2200 DEL PASO BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-3102
Practice Address - Country:US
Practice Address - Phone:916-642-1867
Practice Address - Fax:844-491-6066
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty