Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | ||
N | 225000000X | Orthotic Fitter |
NPI | 1336617315 |
---|---|
Provider Name | Gerardo C Guzman |
First Address | San Diego, CA 92120-3428 |
Second Address | San Diego, CA 92120-3428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2018 |
Last Update Date | 07/11/2018 |