Provider Demographics
NPI:1639948581
Name:MOZO GUZMAN, GIRLY STHEPHANY
Entity Type:Individual
Prefix:
First Name:GIRLY
Middle Name:STHEPHANY
Last Name:MOZO GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2766 S KITCHEN DR
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-5329
Mailing Address - Country:US
Mailing Address - Phone:409-527-2570
Mailing Address - Fax:
Practice Address - Street 1:2766 S KITCHEN DR
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5329
Practice Address - Country:US
Practice Address - Phone:409-527-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider