Healthcare Provider Details

I. General information

NPI: 1578902144
Provider Name (Legal Business Name): CLAUDIA ALEXANDRA DELIZ-GUZMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2013
Last Update Date: 12/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 BRENTWOOD STAIR RD SUITE 200
FORT WORTH TX
76112-3200
US

IV. Provider business mailing address

6451 BRENTWOOD STAIR RD SUITE 200
FORT WORTH TX
76112-3200
US

V. Phone/Fax

Practice location:
  • Phone: 817-496-9700
  • Fax: 817-496-9889
Mailing address:
  • Phone: 817-496-9700
  • Fax: 817-496-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ9146
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: