Provider Demographics
NPI:1700155363
Name:GUZMAN, SHANNON M (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10775 PIONEER TRL STE 215
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0234
Mailing Address - Country:US
Mailing Address - Phone:415-424-4266
Mailing Address - Fax:209-370-9034
Practice Address - Street 1:10775 PIONEER TRL STE 215
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0234
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:209-370-9034
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110003962363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant