Healthcare Provider Details

I. General information

NPI: 1336897750
Provider Name (Legal Business Name): JOSE MORALES GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E WASHINGTON ST STE 100
ANN ARBOR MI
48104-2057
US

IV. Provider business mailing address

505 E KINGSLEY ST APT 2
ANN ARBOR MI
48104-1163
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-3471
  • Fax:
Mailing address:
  • Phone: 909-771-8637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: