Healthcare Provider Details

I. General information

NPI: 1720576127
Provider Name (Legal Business Name): GABRIEL NICOLAS GUZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

3400 DATA DR ATTENTION: CREDENTIALING/PAYER ENROLLMENT DEPARTMENT
RANCHO CORDOVA CA
95670
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-0063
  • Fax: 651-254-5535
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA195798
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number68990
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number68990
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: