Healthcare Provider Details

I. General information

NPI: 1588689723
Provider Name (Legal Business Name): ISRAEL ANTONIO GUZMAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CASIA RIO PIEDRAS #10
RIO PIEDRAS PR
00921
US

IV. Provider business mailing address

AVE.ALVAREZ CHANCA LEVITTOWN CR-9
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-641-7582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22068
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: