Healthcare Provider Details

I. General information

NPI: 1396140802
Provider Name (Legal Business Name): GERARDO GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3062 W COUNTRY FAIR DR
TUCSON AZ
85742-4847
US

IV. Provider business mailing address

3062 W COUNTRY FAIR DR
TUCSON AZ
85742-4847
US

V. Phone/Fax

Practice location:
  • Phone: 520-867-2395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number11357
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: