Provider Demographics
NPI:1104414051
Name:DE GUZMAN, OLIVIA (RN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 LEAFWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-3949
Mailing Address - Country:US
Mailing Address - Phone:415-609-4688
Mailing Address - Fax:
Practice Address - Street 1:3405 LEAFWOOD CT
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-3949
Practice Address - Country:US
Practice Address - Phone:415-609-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415601054372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion