Provider Demographics
NPI:1043223449
Name:DE GUZMAN, RINALDI BRUAL (MD)
Entity Type:Individual
Prefix:DR
First Name:RINALDI
Middle Name:BRUAL
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:8346 118TH ST
Mailing Address - Street 2:APT 3K
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2370
Mailing Address - Country:US
Mailing Address - Phone:718-846-5540
Mailing Address - Fax:
Practice Address - Street 1:130 W KINGSBRIDGE RD
Practice Address - Street 2:OOA-5, SUITE - G
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3904
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:718-741-4407
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY227793207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH82619Medicare UPIN