Healthcare Provider Details

I. General information

NPI: 1801308465
Provider Name (Legal Business Name): KEVIN AGUILA GUZMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE HERNANDEZ CARRION
MANATI PR
00674
US

IV. Provider business mailing address

1223 TOWN RDG
MIDDLETOWN CT
06457-1632
US

V. Phone/Fax

Practice location:
  • Phone: 866-808-5771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number115441
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: