Healthcare Provider Details

I. General information

NPI: 1508274234
Provider Name (Legal Business Name): DUCHESS DE GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 TIEBOUT AVE APT 4
BRONX NY
10458-5466
US

IV. Provider business mailing address

2440 TIEBOUT AVE APT 4
BRONX NY
10458-5466
US

V. Phone/Fax

Practice location:
  • Phone: 646-670-4343
  • Fax:
Mailing address:
  • Phone: 646-670-4343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number429569-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: