Provider Demographics
NPI:1700497666
Name:DE GUZMAN, ALVIN CARL TAMAYO
Entity Type:Individual
Prefix:
First Name:ALVIN CARL
Middle Name:TAMAYO
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 QUASHNICK RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-2515
Mailing Address - Country:US
Mailing Address - Phone:808-436-4639
Mailing Address - Fax:
Practice Address - Street 1:4819 QUASHNICK RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-2515
Practice Address - Country:US
Practice Address - Phone:808-436-4639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95224987163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse