Provider Demographics
NPI:1407620701
Name:GUZMAN LEAL, CARELIZ ANDREINA
Entity Type:Individual
Prefix:
First Name:CARELIZ
Middle Name:ANDREINA
Last Name:GUZMAN LEAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15964 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1154
Mailing Address - Country:US
Mailing Address - Phone:954-806-4786
Mailing Address - Fax:
Practice Address - Street 1:15964 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1154
Practice Address - Country:US
Practice Address - Phone:954-806-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician