Provider Demographics
NPI:1639775349
Name:GUZMAN RIVERA, LEANETTE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LEANETTE
Middle Name:MARIE
Last Name:GUZMAN RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC- 01 BOX 3133
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-9701
Mailing Address - Country:US
Mailing Address - Phone:939-788-0288
Mailing Address - Fax:
Practice Address - Street 1:URB. ESTANCIAS DEL MAYORAL CALLE LA CARRETA D-7
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:939-788-0288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22109208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice