Provider Demographics
NPI:1639651995
Name:GUIRGUIS, HAIDY SAMUEL (FNP)
Entity Type:Individual
Prefix:
First Name:HAIDY
Middle Name:SAMUEL
Last Name:GUIRGUIS
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 1:1262 E ADA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-3782
Mailing Address - Country:US
Mailing Address - Phone:626-327-2011
Mailing Address - Fax:
Practice Address - Street 1:1262 E ADA AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-3782
Practice Address - Country:US
Practice Address - Phone:626-327-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009589363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily