Healthcare Provider Details

I. General information

NPI: 1881443703
Provider Name (Legal Business Name): ALBA REBECCA HERNANDEZ GUZMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N BROAD ST
PHILADELPHIA PA
19140-5189
US

IV. Provider business mailing address

CALLE EMILIO APARICIO #32 ENS JULIETA
SANTO DOMINGO DISTRITO NACIONAL
10130
DO

V. Phone/Fax

Practice location:
  • Phone: 800-836-7536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMT230662
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: