Provider Demographics
NPI:1821722331
Name:GUIZAR, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:GUIZAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 CALIFORNIA WAY UNIT 185
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-1640
Mailing Address - Country:US
Mailing Address - Phone:360-353-2771
Mailing Address - Fax:
Practice Address - Street 1:636 CALIFORNIA WAY UNIT 185
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-1640
Practice Address - Country:US
Practice Address - Phone:360-353-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider