Healthcare Provider Details

I. General information

NPI: 1417642372
Provider Name (Legal Business Name): IVANNA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14401 OLD CUTLER RD
PALMETTO BAY FL
33158-1722
US

IV. Provider business mailing address

16026 SW 66TH TER
MIAMI FL
33193-5513
US

V. Phone/Fax

Practice location:
  • Phone: 305-722-5380
  • Fax:
Mailing address:
  • Phone: 786-406-4584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: