Healthcare Provider Details

I. General information

NPI: 1811003700
Provider Name (Legal Business Name): DR. JULIO E GUZMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 05/21/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 FD AVE ROOSEVELT SUITE 503
HATO REY PR
00918
US

IV. Provider business mailing address

PO BOX 364827
SAN JUAN PR
00936-4827
US

V. Phone/Fax

Practice location:
  • Phone: 787-756-5300
  • Fax: 787-250-0568
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: