Provider Demographics
NPI:1649757337
Name:GUZMAN, MARIVIC (BSN RN, VA-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARIVIC
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:BSN RN, VA-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10981 SAN DIEGO MISSION RD STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2448
Mailing Address - Country:US
Mailing Address - Phone:619-693-7399
Mailing Address - Fax:
Practice Address - Street 1:10981 SAN DIEGO MISSION RD STE 112
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2448
Practice Address - Country:US
Practice Address - Phone:619-693-7399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6622082085R0204X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology