1700155363 NPI number — SHANNON MARIE GUZMAN DMSC, PA-C

Table of content: SHANNON MARIE GUZMAN DMSC, PA-C (NPI 1700155363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700155363 NPI number — SHANNON MARIE GUZMAN DMSC, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUZMAN
Provider First Name:
SHANNON
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMSC, PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700155363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8300 ESTERS BLVD STE 900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75063-2233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-424-2666
Provider Business Mailing Address Fax Number:
415-520-6633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10775 PIONEER TRL STE 215
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUCKEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96161-0234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-424-4266
Provider Business Practice Location Address Fax Number:
209-370-9034
Provider Enumeration Date:
12/27/2011

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: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 003286773A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2200821 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250016698 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30017641300001 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 830115312 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117506800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700155363 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100240434 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000199549 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117506800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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