Provider Demographics
NPI:1497401426
Name:MEDICUS PROVIDER SERVICES INC
Entity Type:Organization
Organization Name:MEDICUS PROVIDER SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:T
Authorized Official - Last Name:DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:818-212-9260
Mailing Address - Street 1:24808 SAND WEDGE LN
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2315
Mailing Address - Country:US
Mailing Address - Phone:818-212-9260
Mailing Address - Fax:
Practice Address - Street 1:29490 KRISTINE CT
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91387-1404
Practice Address - Country:US
Practice Address - Phone:818-212-9260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty