Provider Demographics
NPI:1851589485
Name:JOHN J. GUAGENTI, M.D. INC.
Entity Type:Organization
Organization Name:JOHN J. GUAGENTI, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUAGENTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-242-6357
Mailing Address - Street 1:1510 S CENTRAL AVE
Mailing Address - Street 2:SUITE 470
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2500
Mailing Address - Country:US
Mailing Address - Phone:818-242-6357
Mailing Address - Fax:818-242-3628
Practice Address - Street 1:1510 S CENTRAL AVE
Practice Address - Street 2:SUITE 470
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2500
Practice Address - Country:US
Practice Address - Phone:818-242-6357
Practice Address - Fax:818-242-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91484Medicare UPIN