Provider Demographics
NPI:1124693528
Name:GUZMAN, NATALIA GUADALUPE (FNP)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:GUADALUPE
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8344 N COOPER PL
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-1552
Mailing Address - Country:US
Mailing Address - Phone:818-209-6676
Mailing Address - Fax:
Practice Address - Street 1:11645 WILSHIRE BLVD STE 605
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6842
Practice Address - Country:US
Practice Address - Phone:424-644-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030145207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine