Provider Demographics
NPI:1821432378
Name:DE GUZMAN, EARL ANDREW BALAYAN (MD)
Entity Type:Individual
Prefix:
First Name:EARL ANDREW
Middle Name:BALAYAN
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 W GARVEY AVE N
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2138
Mailing Address - Country:US
Mailing Address - Phone:626-960-4844
Mailing Address - Fax:626-856-3010
Practice Address - Street 1:1511 W GARVEY AVE N
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2138
Practice Address - Country:US
Practice Address - Phone:626-960-4844
Practice Address - Fax:626-856-3010
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1323702084P0015X, 2084P0800X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program