Provider Demographics
NPI:1417443441
Name:GUZMAN, LUIS
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 ROLFE SQ
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2809
Mailing Address - Country:US
Mailing Address - Phone:401-383-4800
Mailing Address - Fax:
Practice Address - Street 1:29 ROLFE SQUARE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:MA
Practice Address - Zip Code:02910
Practice Address - Country:US
Practice Address - Phone:401-383-4800
Practice Address - Fax:401-383-0288
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment