Healthcare Provider Details

I. General information

NPI: 1083713416
Provider Name (Legal Business Name): RAUL J. GUZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CEDAR ST BLDG 204
NEW HAVEN CT
06510
US

IV. Provider business mailing address

PO BOX 208062
NEW HAVEN CT
06520-8062
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2561
  • Fax:
Mailing address:
  • Phone: 203-785-2561
  • Fax: 203-785-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number64013
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: