Provider Demographics
NPI:1679233761
Name:IGNACIO GUZMAN, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:IGNACIO GUZMAN, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-298-9600
Mailing Address - Street 1:1805 E FIR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3859
Mailing Address - Country:US
Mailing Address - Phone:559-298-9600
Mailing Address - Fax:559-298-9605
Practice Address - Street 1:1805 E FIR AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3859
Practice Address - Country:US
Practice Address - Phone:559-298-9600
Practice Address - Fax:559-298-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty