Provider Demographics
NPI:1588442412
Name:GUZMAN, MELODY ELEANOR (NP)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ELEANOR
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 TERMINO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2182
Mailing Address - Country:US
Mailing Address - Phone:310-552-0146
Mailing Address - Fax:
Practice Address - Street 1:1760 TERMINO AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2182
Practice Address - Country:US
Practice Address - Phone:310-552-0146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025633363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health