Provider Demographics
NPI:1699069229
Name:LANI DE GUZMAN
Entity type:Organization
Organization Name:LANI DE GUZMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LANI
Authorized Official - Middle Name:
Authorized Official - Last Name:DE GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-393-2792
Mailing Address - Street 1:1130 N. CAMPBELL ST
Mailing Address - Street 2:110
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-1674
Mailing Address - Country:US
Mailing Address - Phone:213-393-2792
Mailing Address - Fax:213-406-8014
Practice Address - Street 1:1130 CAMPBELL ST
Practice Address - Street 2:110
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-1674
Practice Address - Country:US
Practice Address - Phone:213-393-2792
Practice Address - Fax:213-406-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200415-0002-7251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health