Healthcare Provider Details

I. General information

NPI: 1710863527
Provider Name (Legal Business Name): PEDRO GUZMAN TAPIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 AVE PONCE DE LEON STE 1
SAN JUAN PR
00907-3641
US

IV. Provider business mailing address

1112 CALLE GUADALAJARA
CAROLINA PR
00983-1641
US

V. Phone/Fax

Practice location:
  • Phone: 954-231-5484
  • Fax: 239-379-4385
Mailing address:
  • Phone: 787-547-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4220
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: