1437224896 NPI number — DR. ANGELINE YAGUE DE GUZMAN M.D.

Table of content: DR. ANGELINE YAGUE DE GUZMAN M.D. (NPI 1437224896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437224896 NPI number — DR. ANGELINE YAGUE DE GUZMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE GUZMAN
Provider First Name:
ANGELINE
Provider Middle Name:
YAGUE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE GUZMAN
Provider Other First Name:
ANGELINE
Provider Other Middle Name:
YAGUE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437224896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 EAST COOK STREET
Provider Second Line Business Mailing Address:
SUITE K
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-922-2477
Provider Business Mailing Address Fax Number:
805-922-2669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 EAST COOK STREET
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-922-2477
Provider Business Practice Location Address Fax Number:
805-922-2669
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  A50299 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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