Provider Demographics
NPI:1639643224
Name:GUZMAN, ASHLEY (PA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W COLORADO BLVD STE 431
Mailing Address - Street 2:PAVILION II
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-7701
Mailing Address - Country:US
Mailing Address - Phone:214-947-3684
Mailing Address - Fax:214-947-3686
Practice Address - Street 1:221 W COLORADO BLVD STE 431
Practice Address - Street 2:PAVILION II
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-7701
Practice Address - Country:US
Practice Address - Phone:214-947-3684
Practice Address - Fax:214-947-3686
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant