Healthcare Provider Details

I. General information

NPI: 1972750917
Provider Name (Legal Business Name): RODNEY J GUZA BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 MAIN AVE
BROOKINGS SD
57006-1424
US

IV. Provider business mailing address

8800 SE SUNNYSIDE RD STE 300N
CLACKAMAS OR
97015-5703
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-1024
  • Fax: 507-532-7295
Mailing address:
  • Phone: 281-286-2999
  • Fax: 512-607-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number314 H
License Number StateSD
# 3
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2637
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: