Provider Demographics
NPI:1649753872
Name:ROMAN GUZMAN, IBIS MELISSA (DC)
Entity Type:Individual
Prefix:DR
First Name:IBIS
Middle Name:MELISSA
Last Name:ROMAN GUZMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:IBIS
Other - Middle Name:M
Other - Last Name:ROMAN GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:28 CALLE SAN GERONIMO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-5320
Mailing Address - Country:US
Mailing Address - Phone:787-375-4820
Mailing Address - Fax:
Practice Address - Street 1:111 BO CRUCE DAVILA
Practice Address - Street 2:
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617
Practice Address - Country:US
Practice Address - Phone:787-375-4820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor