Healthcare Provider Details

I. General information

NPI: 1437805603
Provider Name (Legal Business Name): ROBIN EUGENIO GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2022
Last Update Date: 02/26/2022
Certification Date: 02/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 E FORDHAM RD
BRONX NY
10458-5015
US

IV. Provider business mailing address

538 E FORDHAM RD
BRONX NY
10458-5015
US

V. Phone/Fax

Practice location:
  • Phone: 347-630-2323
  • Fax: 718-295-2404
Mailing address:
  • Phone: 347-630-2323
  • Fax: 718-295-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number20-166
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: