Healthcare Provider Details

I. General information

NPI: 1184678948
Provider Name (Legal Business Name): MANUEL ANTONIO GUZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE RAMON GOMEZ 2 SUR URB PEREYO
HUMACAO PR
00791
US

IV. Provider business mailing address

PASEO DEL RIO 500 BLVD DEL RIO 5201
HUMACAO PR
00791
US

V. Phone/Fax

Practice location:
  • Phone: 787-852-4343
  • Fax: 787-285-6559
Mailing address:
  • Phone: 787-585-7095
  • Fax: 787-285-6559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15113
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: