Provider Demographics
NPI:1184678948
Name:GUZMAN, MANUEL ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ANTONIO
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PASEO DEL RIO 500
Mailing Address - Street 2:BLVD DEL RIO 5201
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-585-7095
Mailing Address - Fax:787-285-6559
Practice Address - Street 1:CALLE RAMON GOMEZ 2 SUR
Practice Address - Street 2:URB PEREYO
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-852-4343
Practice Address - Fax:787-285-6559
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2010-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15113208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
222046UOtherSSS
100873OtherCRUZ AZUL
222046UOtherSSS
0022204Medicare ID - Type Unspecified