Provider Demographics
NPI:1497180277
Name:DE GUZMAN, LISA GLORINDA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:GLORINDA
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 1:18143 HOMELAND LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-8216
Mailing Address - Country:US
Mailing Address - Phone:909-228-0378
Mailing Address - Fax:
Practice Address - Street 1:3611 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:102
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2685
Practice Address - Country:US
Practice Address - Phone:310-608-3600
Practice Address - Fax:310-608-3661
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily