Healthcare Provider Details

I. General information

NPI: 1417584624
Provider Name (Legal Business Name): JOSE MOSCO-GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MANATEE AVE W
BRADENTON FL
34205-8805
US

IV. Provider business mailing address

316 MANATEE AVE W
BRADENTON FL
34205-8805
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-2277
  • Fax:
Mailing address:
  • Phone: 941-748-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS23285
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS23285
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: