Provider Demographics
NPI:1679199731
Name:GUZMAN PEREZ, LAURA M (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:GUZMAN PEREZ
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:FONT BERNARD #4 , SAN GERONIMO
Mailing Address - Street 2:
Mailing Address - City:SANTO DOMINGO
Mailing Address - State:DISTRITO NACIONAL
Mailing Address - Zip Code:10104
Mailing Address - Country:DO
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:82-68 164TH STREET JAMAICA
Practice Address - Street 2:
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-883-4847
Practice Address - Fax:718-883-6197
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2022-03-01
Deactivation Date:2022-01-17
Deactivation Code:
Reactivation Date:2022-03-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program