Healthcare Provider Details

I. General information

NPI: 1134867542
Provider Name (Legal Business Name): YAMILET GUZMAN CBHCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 NW 82ND AVE
DORAL FL
33126-1011
US

IV. Provider business mailing address

20820 NE 6TH AVE
MIAMI FL
33179-3582
US

V. Phone/Fax

Practice location:
  • Phone: 786-420-5924
  • Fax: 786-542-5340
Mailing address:
  • Phone: 786-469-0325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCBHCM102418
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: