Provider Demographics
NPI:1003162264
Name:EDUARDO GUZMAN, MDPA
Entity Type:Organization
Organization Name:EDUARDO GUZMAN, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/TREASURER/DIRECTOR/SEC
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-445-2404
Mailing Address - Street 1:1800 SW 27TH AVE
Mailing Address - Street 2:402
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2457
Mailing Address - Country:US
Mailing Address - Phone:305-445-2404
Mailing Address - Fax:305-443-8759
Practice Address - Street 1:1800 SW 27TH AVE
Practice Address - Street 2:402
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2457
Practice Address - Country:US
Practice Address - Phone:305-445-2404
Practice Address - Fax:305-443-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM0014466174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049946300Medicaid
FLD65620Medicare UPIN
FL91227Medicare PIN