Healthcare Provider Details

I. General information

NPI: 1194736181
Provider Name (Legal Business Name): SARA INES GUZMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 HODGES BLVD STE 1
JACKSONVILLE FL
32224-2345
US

IV. Provider business mailing address

4500 HODGES BLVD STE 1
JACKSONVILLE FL
32224-2345
US

V. Phone/Fax

Practice location:
  • Phone: 904-347-2773
  • Fax: 904-647-2647
Mailing address:
  • Phone: 904-347-2773
  • Fax: 904-647-2647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME112812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: