Basic Information
| Provider Information | |||||||||
| NPI: | 1801191168 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUZMAN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 889 LOS POSITOS DR | ||||||||
| Address2: | |||||||||
| City: | MILPITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950354514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082303330 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2005 KNIGHT LANE BLDG H | ||||||||
| Address2: | MEDICAL STAFF SERVICES, NAVY MEDICINE SUPPORT COMMAND | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322120140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195328038 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2011 | ||||||||
| LastUpdateDate: | 01/18/2011 | ||||||||
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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 | 367500000X | 620584 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.