Healthcare Provider Details

I. General information

NPI: 1538184221
Provider Name (Legal Business Name): MA ROSARIO C GUZMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/01/2025
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 KUPAOA STREET UNIT B-101
MAKAWAO HI
96768
US

IV. Provider business mailing address

40 KUPAOA STREET UNIT B-101
MAKAWAO HI
96768
US

V. Phone/Fax

Practice location:
  • Phone: 808-215-6845
  • Fax: 808-646-7383
Mailing address:
  • Phone: 808-215-6845
  • Fax: 808-646-7383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD12780
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: