Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | G40600 | CA |
N | 101YM0800X | Mental Health Counselor | G40600 | CA |
N | 207Q00000X | Family Doctor | G40600 | CA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | G40600 | CA |
N | 2081P2900X | Pain Medicine | G40600 | CA |
NPI | 1265422695 |
---|---|
Provider Name | Dr. Richard Victor Guzzetta |
First Address | Clovis, CA 93611-6811 |
Second Address | Clovis, CA 93611-6811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 03/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G406000 | (05) | CA |
A48286 | (02) | CA |