Provider Demographics
NPI:1154982098
Name:DE GUZMAN, CLARENCE LONDRES
Entity type:Individual
Prefix:
First Name:CLARENCE
Middle Name:LONDRES
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21250 BOX SPRINGS RD STE 212
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8712
Mailing Address - Country:US
Mailing Address - Phone:951-300-0457
Mailing Address - Fax:
Practice Address - Street 1:21250 BOX SPRINGS RD STE 212
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8712
Practice Address - Country:US
Practice Address - Phone:951-300-0457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator