Healthcare Provider Details

I. General information

NPI: 1659784643
Provider Name (Legal Business Name): LAURA ARVIDSON-GUZMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST BOX 286
BOSTON MA
02111-1552
US

IV. Provider business mailing address

800 WASHINGTON ST BOX 286
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5078
  • Fax: 617-636-8391
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number259488
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: