Provider Demographics
NPI:1487742979
Name:BENNY J. GUZMAN, M.D., CORPORATION
Entity type:Organization
Organization Name:BENNY J. GUZMAN, M.D., CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-613-0016
Mailing Address - Street 1:5827 PINE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6534
Mailing Address - Country:US
Mailing Address - Phone:909-613-0016
Mailing Address - Fax:909-613-0026
Practice Address - Street 1:5827 PINE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6534
Practice Address - Country:US
Practice Address - Phone:909-613-0016
Practice Address - Fax:909-613-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72290390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A722901Medicaid
CA00A722900Medicaid
CA00A722901Medicaid
CAH51139Medicare UPIN