Healthcare Provider Details

I. General information

NPI: 1164196416
Provider Name (Legal Business Name): EDUARDO GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 W FLAGLER ST APT 802
MIAMI FL
33130-1383
US

IV. Provider business mailing address

556 W FLAGLER ST APT 802
MIAMI FL
33130-1383
US

V. Phone/Fax

Practice location:
  • Phone: 786-857-2571
  • Fax:
Mailing address:
  • Phone: 786-857-2571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-156269
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: