MEDICARE: ATHENA BARCELONA GUZMAN M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036054418	IL

General Provider Information

NPI Number	:	1457609430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATHENA BARCELONA GUZMAN M.D

Provider Business Mailing Address
First Line	:	3038 10TH ST
Second Line	:
City	:	EAST MOLINE
State	:	IL
Zip	:	61244-3239
Country	:	US
Telephone Number	:	425-802-6495
Fax Number	:

Provider Business Practice Location Address
First Line	:	3038 10TH ST
Second Line	:
City	:	EAST MOLINE
State	:	IL
Zip	:	61244-3239
Country	:	US
Telephone Number	:	425-802-6495
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2012
Last Update Date	:	08/22/2012

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