Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT297630 | CA |
NPI | 1053957241 |
---|---|
Provider Name | Ryan Guzman |
First Address | Tustin, CA 92780-1813 |
Second Address | Laguna Hills, CA 92653-1354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2019 |
Last Update Date | 22/11/2019 |