Provider Demographics
NPI:1114228483
Name:GUZMAN, CHARLIE RAUL
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:RAUL
Last Name: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 1:402 FARNEL RD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4960
Mailing Address - Country:US
Mailing Address - Phone:805-264-1306
Mailing Address - Fax:805-922-6543
Practice Address - Street 1:402 FARNEL RD STE A
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4960
Practice Address - Country:US
Practice Address - Phone:805-264-1306
Practice Address - Fax:805-922-6543
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist