Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 18178 | MS |
Y | 207PE0004X | Emergency Medical Services | MD2010-0102 | NM |
NPI | 1073517686 |
---|---|
Provider Name | Dr. Victoria De Guzman Fernando |
First Address | Clovis, NM 88101 |
Second Address | Clovis, NM 88101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 28/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00737798 | (05) | MS |
BF8479506 | DEA (01) | |
H91947 | (02) |