Victor Lao De Guzman Jr., AGACNP-BC, ACNPC-AG

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

AP60951857 Issued in WA

Practice address

1717 S J St
Tacoma, WA 98405-4933

Phone

(253) 426-6341

Fax

(253) 761-1040

NPI assigned

Aug 7, 2018

Last updated

Dec 2, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HFBCCD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Providence Health & Services Washington

  dba Providence Medical Group SouthWest Washington

  • Family Medicine Physician
  • Olympia, WA
  • NPI 1174744304
  Medicare reassignment NPD
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Olympia, WA
  • NPI 1619176997
  Medicare reassignment NPD
• Padmini Bhadriraju MD P.a.

  dba Catalyst Hospitalists Group

  • Hospitalist Physician
  • Edinburg, TX
  • NPI 1619278876
  Medicare reassignment NPD
• Providence Health & Services Washington

  dba Providence Community Care Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Olympia, WA
  • NPI 1023550050
  NPD
• Providence Health & Services Washington

  dba Providence Medical Group Southwest Washington

  • General Practice Physician
  • Olympia, WA
  • NPI 1134656135
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606867200000",
    "number": "1497234884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 S J ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054933",
            "telephone_number": "253-426-6341",
            "fax_number": "253-761-1040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S J ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054933",
            "telephone_number": "253-426-6341",
            "fax_number": "253-761-1040"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5501 S Expressway 77",
            "address_purpose": "LOCATION",
            "city": "Harlingen",
            "state": "TX",
            "postal_code": "785503213",
            "country_code": "US",
            "telephone_number": "956-365-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1455 Battersby Ave",
            "address_purpose": "LOCATION",
            "city": "Enumclaw",
            "state": "WA",
            "postal_code": "98022",
            "country_code": "US",
            "telephone_number": "253-426-6341",
            "fax_number": "253-426-6344",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE GUZMAN",
        "first_name": "VICTOR",
        "middle_name": "LAO",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "AGACNP-BC, ACNPC-AG",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-07",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60951857",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TX",
            "license": "AP138293",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WA",
            "license": "AP60951857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2138777",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vdeguzman509162@fhsce.catholichealth.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1717 S J St",
            "city": "Tacoma",
            "state": "WA",
            "country_code": "US",
            "postal_code": "984054933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Daylight Counseling, PLLC
• Matthew C Dayoe, EMT
• DC Positive Therapy, LLC
• Donald Babalcon De Guzman, DPT
• Noriko De Guzman, MA
• Maria De la Cerda
• Rose Marie De la Fuente
• Liz De la Nuez-Saez
• Robert De la Pena Jr.
• Adriana De la Rosa

• Gerontology Nurse Practitioner in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Gerontology Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.