Healthcare Provider Details

I. General information

NPI: 1053596114
Provider Name (Legal Business Name): MELVIN GUZMAN M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 LEE RD
WINTER PARK FL
32789-1750
US

IV. Provider business mailing address

16256 OLD ASH LOOP
ORLANDO FL
32828-6906
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-7451
  • Fax: 407-862-2737
Mailing address:
  • Phone: 407-928-2877
  • 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: