Provider Demographics
NPI:1952032955
Name:DE GUZMAN, VILCENT MERZA (FNP)
Entity Type:Individual
Prefix:
First Name:VILCENT
Middle Name:MERZA
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 W 118TH ST STE 409
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-2259
Mailing Address - Country:US
Mailing Address - Phone:310-219-0647
Mailing Address - Fax:
Practice Address - Street 1:4477 W 118TH ST STE 409
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2259
Practice Address - Country:US
Practice Address - Phone:310-219-0647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily