MEDICARE: MARIA KARINA GUZMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1598306219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA KARINA GUZMAN

Provider Business Mailing Address
First Line	:	1814 W OWEN K GARRIOTT RD
Second Line	:
City	:	ENID
State	:	OK
Zip	:	73703-5525
Country	:	US
Telephone Number	:	580-823-8017
Fax Number	:

Provider Business Practice Location Address
First Line	:	4305 NW 60TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-1318
Country	:	US
Telephone Number	:	580-278-5628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2019
Last Update Date	:	10/03/2019

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