Provider Demographics
NPI:1548874407
Name:GUZMAN, KELLY CASSANDRA
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:CASSANDRA
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 BLUESTONE RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9259
Mailing Address - Country:US
Mailing Address - Phone:609-251-0949
Mailing Address - Fax:
Practice Address - Street 1:1102 BLUESTONE RIVER WAY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9259
Practice Address - Country:US
Practice Address - Phone:609-251-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty