Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 95030145 | CA |
NPI | 1124693528 |
---|---|
Provider Name | Natalia Guadalupe Guzman |
First Address | Winnetka, CA 91306-1552 |
Second Address | Los Angeles, CA 90025-6842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2021 |
Last Update Date | 26/05/2021 |