Healthcare Provider Details

I. General information

NPI: 1568443232
Provider Name (Legal Business Name): JHON SAUL GUZMAN-RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5503 S CONGRESS AVE SUITE 103
ATLANTIS FL
33462-6614
US

IV. Provider business mailing address

5503 S CONGRESS AVE SUITE 103
ATLANTIS FL
33462-6614
US

V. Phone/Fax

Practice location:
  • Phone: 561-965-7228
  • Fax: 561-965-0120
Mailing address:
  • Phone: 561-965-7228
  • Fax: 561-965-5889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME75394
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME75394
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: