Healthcare Provider Details

I. General information

NPI: 1306716709
Provider Name (Legal Business Name): MARTA ENID GUZMAN VEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB BRISAS DEL LAUREL CALLE FLAMBOYAN #1029
COTO LAUREL PR
00780
US

IV. Provider business mailing address

URB BRISAS DEL LAUREL CALLE FLAMBOYAN #1029
COTO LAUREL PR
00780
US

V. Phone/Fax

Practice location:
  • Phone: 939-639-8308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8281
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: