Provider Demographics
NPI:1629373501
Name:GUZMAN, PRISCILLA JOHANNA
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:JOHANNA
Last Name: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 1:5101 FLORENCE AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3801
Mailing Address - Country:US
Mailing Address - Phone:323-560-8847
Mailing Address - Fax:
Practice Address - Street 1:5101 FLORENCE AVE STE 9
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-3801
Practice Address - Country:US
Practice Address - Phone:323-560-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program