Healthcare Provider Details

I. General information

NPI: 1134032469
Provider Name (Legal Business Name): JESSE CAMILA GUZMAN RODRIGUEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8114 QUEENS BLVD
ELMHURST NY
11373-3789
US

IV. Provider business mailing address

7510 YELLOWSTONE BLVD APT 5H
REGO PARK NY
11374-5308
US

V. Phone/Fax

Practice location:
  • Phone: 949-424-3337
  • Fax: 929-424-3347
Mailing address:
  • Phone: 786-461-8549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360924-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: