Provider Demographics
NPI:1639662620
Name:DE GUZMAN, NIKKAELA ANIKEN BONIFACIO
Entity Type:Individual
Prefix:
First Name:NIKKAELA ANIKEN
Middle Name:BONIFACIO
Last Name: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 1:2220 LAKE RD APT B1
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3221
Mailing Address - Country:US
Mailing Address - Phone:415-919-8499
Mailing Address - Fax:
Practice Address - Street 1:2220 LAKE RD APT B1
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3221
Practice Address - Country:US
Practice Address - Phone:415-919-8499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8995379OtherKAISER