Healthcare Provider Details

I. General information

NPI: 1316557572
Provider Name (Legal Business Name): PEDRO JOSE CRUZ GUZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC CRITICAL CARE MEDICINE
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC CRITICAL CARE MEDICINE
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 180-087-9246
  • Fax:
Mailing address:
  • Phone: 180-087-9246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2222551
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD495234
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: