Provider Demographics
NPI:1245958917
Name:DE GUZMAN, AIDA JIMENEZ
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:JIMENEZ
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 SCHOOL ST STE B
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2433
Mailing Address - Country:US
Mailing Address - Phone:650-994-2234
Mailing Address - Fax:
Practice Address - Street 1:102 ENCINAL AVE
Practice Address - Street 2:
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3103
Practice Address - Country:US
Practice Address - Phone:650-580-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA668165163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management