Healthcare Provider Details

I. General information

NPI: 1285450429
Provider Name (Legal Business Name): MIKAELA ALEXANDRA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKAELA ALEXADRA GUZMAN N/A

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17772 SW 2ND ST
PEMBROKE PINES FL
33029-3926
US

IV. Provider business mailing address

17773 SW 2ND ST
PEMBROKE PINES FL
33029-3924
US

V. Phone/Fax

Practice location:
  • Phone: 954-589-2347
  • Fax: 954-301-2246
Mailing address:
  • Phone: 954-589-2347
  • Fax: 954-301-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: