Healthcare Provider Details

I. General information

NPI: 1124726112
Provider Name (Legal Business Name): MARIA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6008 SE 84TH ST
OKLAHOMA CITY OK
73135-6005
US

IV. Provider business mailing address

6008 SE 84TH ST
OKLAHOMA CITY OK
73135-6005
US

V. Phone/Fax

Practice location:
  • Phone: 806-330-1463
  • Fax:
Mailing address:
  • Phone: 806-330-1463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: