Provider Demographics
NPI:1710988035
Name:GUZMAN, BENNY J (MD)
Entity Type:Individual
Prefix:
First Name:BENNY
Middle Name:J
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5827 PINE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6534
Mailing Address - Country:US
Mailing Address - Phone:909-613-0016
Mailing Address - Fax:909-613-0026
Practice Address - Street 1:5827 PINE AVE
Practice Address - Street 2:STE A
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6534
Practice Address - Country:US
Practice Address - Phone:909-613-0016
Practice Address - Fax:909-613-0026
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA72290207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A722901Medicaid
CA00A722900Medicaid
CAH51139Medicare UPIN
CA00A722901Medicaid