Healthcare Provider Details

I. General information

NPI: 1134447774
Provider Name (Legal Business Name): JACOB ESAU GUZMAN CALDERON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

IV. Provider business mailing address

320 E NORTH AVE
PITTSBURGH PA
15212-4756
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-6581
  • Fax: 412-359-3483
Mailing address:
  • Phone: 412-359-6581
  • Fax: 412-359-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD456240
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: