Provider Demographics
NPI:1245564293
Name:GUZMAN, LUIS (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 SAXON BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8357
Mailing Address - Country:US
Mailing Address - Phone:386-917-0001
Mailing Address - Fax:386-917-0008
Practice Address - Street 1:902 SAXON BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8357
Practice Address - Country:US
Practice Address - Phone:386-917-0001
Practice Address - Fax:386-917-0008
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2369237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist