Provider Demographics
NPI:1902657323
Name:DE GUZMAN, CARL D (OTR)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:D
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13701 MARINA POINTE DR APT 415
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-9245
Mailing Address - Country:US
Mailing Address - Phone:424-387-1756
Mailing Address - Fax:
Practice Address - Street 1:8757 BURTON WAY
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-3839
Practice Address - Country:US
Practice Address - Phone:424-387-1756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26207225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist