Provider Demographics
NPI:1053367896
Name:ISAIAS DE GUZMAN PAJA JR. MD INC
Entity type:Organization
Organization Name:ISAIAS DE GUZMAN PAJA JR. MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISAIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PAJA
Authorized Official - Suffix:
Authorized Official - Credentials:A56363
Authorized Official - Phone:213-484-9934
Mailing Address - Street 1:1800 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3602
Mailing Address - Country:US
Mailing Address - Phone:213-484-9934
Mailing Address - Fax:213-484-9939
Practice Address - Street 1:1800 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3602
Practice Address - Country:US
Practice Address - Phone:213-484-9934
Practice Address - Fax:213-484-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053367896Medicaid
CAGR 0100110Medicaid