Basic Information
| Provider Information | |||||||||
| NPI: | 1770895724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUZMAN | ||||||||
| FirstName: | IGNACIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1805 E FIR AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592989600 | ||||||||
| FaxNumber: | 5592989605 | ||||||||
| Practice Location | |||||||||
| Address1: | 1805 E FIR AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592989600 | ||||||||
| FaxNumber: | 5592989605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2010 | ||||||||
| LastUpdateDate: | 10/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A113019 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A0113019 | 01 | CA | CA MEDICAL LICENSE | OTHER |