Provider Demographics
NPI:1982785739
Name:GUZMAN, HORTENCIA (16436)
Entity Type:Individual
Prefix:
First Name:HORTENCIA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:16436
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3490 PALM AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154
Mailing Address - Country:US
Mailing Address - Phone:619-423-5616
Mailing Address - Fax:619-423-8564
Practice Address - Street 1:3490 PALM AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154
Practice Address - Country:US
Practice Address - Phone:619-423-5616
Practice Address - Fax:619-423-8564
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA16436OtherPHYSICIAN ASSISTANT