Provider Demographics
NPI:1659825404
Name:GUZMAN, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name: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 1:8339 DIANA MARIE DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-2606
Mailing Address - Country:US
Mailing Address - Phone:209-478-9862
Mailing Address - Fax:209-478-1938
Practice Address - Street 1:6 S EL DORADO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2804
Practice Address - Country:US
Practice Address - Phone:209-478-9862
Practice Address - Fax:209-478-1938
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator