Provider Demographics
NPI:1962641472
Name:GUARDIAN CLINICAL SERVICES
Entity Type:Organization
Organization Name:GUARDIAN CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:PEDDICORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:559-909-1965
Mailing Address - Street 1:790 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-2419
Mailing Address - Country:US
Mailing Address - Phone:559-909-1965
Mailing Address - Fax:
Practice Address - Street 1:790 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-2419
Practice Address - Country:US
Practice Address - Phone:559-909-1965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA696799251J00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies