Healthcare Provider Details

I. General information

NPI: 1497349427
Provider Name (Legal Business Name): BRENDA IVELY GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2021
Last Update Date: 02/20/2021
Certification Date: 02/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5198 RICHMOND RD
BEDFORD HEIGHTS OH
44146-1331
US

IV. Provider business mailing address

2707 MILLS DR
LORAIN OH
44052-4117
US

V. Phone/Fax

Practice location:
  • Phone: 216-378-9101
  • Fax:
Mailing address:
  • Phone: 440-204-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: