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Individual
MR. MICKEY DE GUZMAN CHAN
Active
Individual
MR. MICKEY DE GUZMAN CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMSC, MHSC, PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA65304
CA
363AM0700X
Medical Physician Assistant
PA65304
CA
363AS0400X
Surgical Physician Assistant
PA65304
CA
Other
Enumeration date
05/29/2024
Last updated
05/16/2025
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