Healthcare Provider Details

I. General information

NPI: 1952390064
Provider Name (Legal Business Name): MINA LOURDES T GUZMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3964 HAMILTON SQUARE BLVD
GROVEPORT OH
43125-9119
US

IV. Provider business mailing address

4367 BENNINGTON CREEK LN
GROVEPORT OH
43125-8900
US

V. Phone/Fax

Practice location:
  • Phone: 614-834-6800
  • Fax:
Mailing address:
  • Phone: 614-916-3916
  • Fax: 775-599-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35072875
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: