Healthcare Provider Details

I. General information

NPI: 1902376809
Provider Name (Legal Business Name): RICHARD DAVID GUZMAN BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 3RD ST NW
ALBUQUERQUE NM
87102-1403
US

IV. Provider business mailing address

PO BOX 27258
ALBUQUERQUE NM
87125-7258
US

V. Phone/Fax

Practice location:
  • Phone: 505-764-8231
  • Fax: 505-241-1351
Mailing address:
  • Phone: 505-764-8231
  • Fax: 505-241-1351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: