Provider Demographics
NPI:1568940252
Name:SANTOS DE GUZMAN, ASHLEY JEAN
Entity Type:Individual
Prefix:
First Name:ASHLEY JEAN
Middle Name:
Last Name:SANTOS DE GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31537 HUGH WAY
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-7743
Mailing Address - Country:US
Mailing Address - Phone:702-480-9696
Mailing Address - Fax:
Practice Address - Street 1:2608 CENTRAL AVE STE 1
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3148
Practice Address - Country:US
Practice Address - Phone:510-675-0600
Practice Address - Fax:510-675-0185
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95166125163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse