Provider Demographics
NPI:1104192806
Name:ROSA GUZMAN MD PA
Entity Type:Organization
Organization Name:ROSA GUZMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-686-5311
Mailing Address - Street 1:2500 BUDDY OWENS
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5464
Mailing Address - Country:US
Mailing Address - Phone:956-686-5311
Mailing Address - Fax:956-686-7690
Practice Address - Street 1:2500 BUDDY OWENS
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5464
Practice Address - Country:US
Practice Address - Phone:956-686-5311
Practice Address - Fax:956-686-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7980208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ7980OtherLICENSE