Healthcare Provider Details

I. General information

NPI: 1649753872
Provider Name (Legal Business Name): IBIS MELISSA ROMAN GUZMAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IBIS M. ROMAN GUZMAN DC

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BO CRUCE DAVILA
BARCELONETA PR
00617
US

IV. Provider business mailing address

28 CALLE SAN GERONIMO
ARECIBO PR
00612-5320
US

V. Phone/Fax

Practice location:
  • Phone: 787-375-4820
  • Fax:
Mailing address:
  • Phone: 787-375-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number659
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: