Healthcare Provider Details

I. General information

NPI: 1841239639
Provider Name (Legal Business Name): YAMIL GUZMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 AVE HOSTOS STE.2100
MAYAGUEZ PR
00680-1251
US

IV. Provider business mailing address

PO BOX 736 LOS VERSALLES
LAJAS PR
00667-0736
US

V. Phone/Fax

Practice location:
  • Phone: 787-834-2280
  • Fax: 787-834-3020
Mailing address:
  • Phone: 787-646-4894
  • Fax: 787-834-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number476-068
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: