Healthcare Provider Details

I. General information

NPI: 1306022512
Provider Name (Legal Business Name): MICHAEL MANUEL GUZMAN MS OTL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 01/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 CALLE TER URB. RIO PIEDRAS HEIGHTS
SAN JUAN PR
00926-3253
US

IV. Provider business mailing address

1710 CALLE TER URB. RIO PIEDRAS HEIGHTS
SAN JUAN PR
00926-3253
US

V. Phone/Fax

Practice location:
  • Phone: 939-639-5560
  • Fax:
Mailing address:
  • Phone: 939-639-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1075
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: