Provider Demographics
NPI:1265422695
Name:GUZZETTA, RICHARD VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:VICTOR
Last Name:GUZZETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:312 5TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-1058
Mailing Address - Country:US
Mailing Address - Phone:559-285-5723
Mailing Address - Fax:559-323-4498
Practice Address - Street 1:312 5TH ST STE B
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1058
Practice Address - Country:US
Practice Address - Phone:559-285-5723
Practice Address - Fax:559-323-4498
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG406002083P0901X, 208VP0000X, 101YA0400X, 101YM0800X, 174400000X, 1744R1102X, 1744R1103X, 207Q00000X, 207QA0401X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist
No1744R1102XOther Service ProvidersSpecialistResearch Study
No1744R1103XOther Service ProvidersSpecialistResearch Data Abstracter/Coder
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G406000Medicaid
CAA48286Medicare UPIN
CA00G40600Medicare ID - Type Unspecified
CA00G406000Medicaid