Provider Demographics
NPI:1154851624
Name:GUZMAN, CORINA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORINA
Middle Name:L
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 5TH AVE APT 5J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7612
Mailing Address - Country:US
Mailing Address - Phone:786-201-0877
Mailing Address - Fax:
Practice Address - Street 1:11645 BISCAYNE BLVD STE 406
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3139
Practice Address - Country:US
Practice Address - Phone:305-892-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN240811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAW201851495OtherAETNA STUDENT HEALTH