Provider Demographics
NPI:1023129293
Name:GUIZADO, ROY A (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:A
Last Name:GUIZADO
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6590 MONTECARLO PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9015
Mailing Address - Country:US
Mailing Address - Phone:909-469-5445
Mailing Address - Fax:909-469-5407
Practice Address - Street 1:1601 MONTE VISTA AVE STE 190
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-6600
Practice Address - Country:US
Practice Address - Phone:909-865-9977
Practice Address - Fax:909-469-2119
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023129293Medicaid