Healthcare Provider Details

I. General information

NPI: 1245710763
Provider Name (Legal Business Name): DIANA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 RUBY ST
FRANKLIN PARK IL
60131-1722
US

IV. Provider business mailing address

3424 RUBY ST
FRANKLIN PARK IL
60131-1722
US

V. Phone/Fax

Practice location:
  • Phone: 224-385-4746
  • Fax:
Mailing address:
  • Phone: 224-385-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number041437933
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: