Provider Demographics
NPI:1609463215
Name:DE GUZMAN, CONCEPCION (NP)
Entity Type:Individual
Prefix:
First Name:CONCEPCION
Middle Name:
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20929 DIVONNE DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2526
Mailing Address - Country:US
Mailing Address - Phone:909-576-7940
Mailing Address - Fax:
Practice Address - Street 1:20929 DIVONNE DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2526
Practice Address - Country:US
Practice Address - Phone:909-576-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015861363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily