Healthcare Provider Details

I. General information

NPI: 1700495033
Provider Name (Legal Business Name): HECTOR GUZMAN SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LOS CANTIZALES APT 4H
SAN JUAN PR
00926-2597
US

IV. Provider business mailing address

1 LOS CANTIZALES APT 4H
SAN JUAN PR
00926-2597
US

V. Phone/Fax

Practice location:
  • Phone: 787-403-6556
  • Fax:
Mailing address:
  • Phone: 787-403-6556
  • Fax: 787-777-3781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11008192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: