Healthcare Provider Details

I. General information

NPI: 1700254802
Provider Name (Legal Business Name): MARIA VICTORIA DE GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA DE GUZMAN

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6544 W THOMAS RD STE 11
PHOENIX AZ
85033-5740
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 602-834-5515
  • Fax: 602-263-5776
Mailing address:
  • Phone: 55-002-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP8111
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP8111
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP8111
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: