Provider Demographics
NPI:1497997456
Name:GUZMAN, LUIS (LIC AC)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 W 16 AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-1140
Mailing Address - Country:US
Mailing Address - Phone:786-274-9837
Mailing Address - Fax:
Practice Address - Street 1:4160 W 16 AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5853
Practice Address - Country:US
Practice Address - Phone:786-274-9837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-06
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2624171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist