Healthcare Provider Details

I. General information

NPI: 1184905721
Provider Name (Legal Business Name): ANNETTE GUZMAN M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 20 BOX 26307
SAN LORENZO PR
00754-9653
US

IV. Provider business mailing address

CARR 183 R 916 K 1 6.0
SAN LORENZO PR
00754
US

V. Phone/Fax

Practice location:
  • Phone: 787-477-8406
  • Fax: 787-746-8079
Mailing address:
  • Phone: 787-477-8406
  • Fax: 787-746-8079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3111
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: