Healthcare Provider Details

I. General information

NPI: 1770962342
Provider Name (Legal Business Name): PAOLA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WESTVIEW AVE 1ST FL
RYE BROOK NY
10573-3435
US

IV. Provider business mailing address

19 WESTVIEW AVE 1ST FL
RYE BROOK NY
10573-3435
US

V. Phone/Fax

Practice location:
  • Phone: 914-481-1515
  • Fax:
Mailing address:
  • Phone: 914-481-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number320544-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: