Provider Demographics
NPI:1487828380
Name:DE GUZMAN, ELEANOR CHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:CHAN
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24148 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2442
Mailing Address - Country:US
Mailing Address - Phone:661-888-4980
Mailing Address - Fax:661-370-0770
Practice Address - Street 1:24148 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2442
Practice Address - Country:US
Practice Address - Phone:661-888-4980
Practice Address - Fax:661-370-0770
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice