Healthcare Provider Details

I. General information

NPI: 1902715790
Provider Name (Legal Business Name): EDIMARIE GARCIA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4553 GRAND BLVD STE 206
NEW PORT RICHEY FL
34652-5157
US

IV. Provider business mailing address

4553 GRAND BLVD STE 206
NEW PORT RICHEY FL
34652-5157
US

V. Phone/Fax

Practice location:
  • Phone: 727-534-3234
  • Fax:
Mailing address:
  • Phone: 727-534-3234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2846446
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: