Provider Demographics
NPI:1740208586
Name:GUZMAN, DAVID LEE (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEE
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3379 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3407
Mailing Address - Country:US
Mailing Address - Phone:707-224-4800
Mailing Address - Fax:707-224-3644
Practice Address - Street 1:3379 BEARD RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3407
Practice Address - Country:US
Practice Address - Phone:707-224-4800
Practice Address - Fax:707-224-3644
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E38250213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0055960Medicaid
CAU27407Medicare UPIN
CAZZZ36574ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER