Provider Demographics
NPI:1578953774
Name:N.J. GUZMAN M.D. PA
Entity Type:Organization
Organization Name:N.J. GUZMAN M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-429-7879
Mailing Address - Street 1:104 E CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-2575
Mailing Address - Country:US
Mailing Address - Phone:352-429-7879
Mailing Address - Fax:352-429-7819
Practice Address - Street 1:104 E CHERRY ST
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-2575
Practice Address - Country:US
Practice Address - Phone:352-429-7879
Practice Address - Fax:352-429-7819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267687700Medicaid