Provider Demographics
NPI:1902866049
Name:GUIDO, GEORGE D III (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:D
Last Name:GUIDO
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2542 S BASCOM AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-5541
Mailing Address - Country:US
Mailing Address - Phone:408-559-3403
Mailing Address - Fax:408-559-3158
Practice Address - Street 1:2542 S BASCOM AVE
Practice Address - Street 2:STE 110
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-5541
Practice Address - Country:US
Practice Address - Phone:408-559-3403
Practice Address - Fax:408-559-3158
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51518363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical