Healthcare Provider Details

I. General information

NPI: 1912322314
Provider Name (Legal Business Name): NINA M. GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2014
Last Update Date: 02/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 2 BOX 13456
AGUAS BUENAS PR
00703-9823
US

IV. Provider business mailing address

HC 2 BOX 13456
AGUAS BUENAS PR
00703-9823
US

V. Phone/Fax

Practice location:
  • Phone: 787-614-2674
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4987
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: