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General NPI Number Information
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NPI Number | 1710084041
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Entity Type | Individual
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Provider Name | BRENDA M GUZMAN-VILLAR MD
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 1919 LAKELAND HILLS BLVD PALM TERRACE OF LAKELAND
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City | LAKELAND
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State | FL
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Zip | 33805-2901
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Country | US
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Telephone | 863-688-5612
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Fax | 863-687-8870
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Provider Business Mailing Address
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Address Line | 401 NORTH MICHIGAN AVE 1200
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City | CHICAGO
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State | IL
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Zip | 60611-4264
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Country | US
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Telephone | 312-635-0973
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Fax | 813-290-9691
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | ME119566
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License Number State | FL
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