Healthcare Provider Details

I. General information

NPI: 1942647656
Provider Name (Legal Business Name): JOHNNY DIMAS GUZMAN DO, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 N ANDREWS AVE
WILTON MANORS FL
33311-3924
US

IV. Provider business mailing address

2307 N ANDREWS AVE
WILTON MANORS FL
33311-3924
US

V. Phone/Fax

Practice location:
  • Phone: 855-955-5428
  • Fax: 844-389-0835
Mailing address:
  • Phone: 855-955-5428
  • Fax: 844-389-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO034618
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS16879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: