Healthcare Provider Details

I. General information

NPI: 1376269092
Provider Name (Legal Business Name): DR. ANA PATRICIA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MAIN ST
SOUTHAMPTON NY
11968-4810
US

IV. Provider business mailing address

111 MAIN ST
SOUTHAMPTON NY
11968-4810
US

V. Phone/Fax

Practice location:
  • Phone: 631-283-4250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI069591
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number069591
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: