Provider Demographics
NPI:1679571467
Name:RUIZ DE GUZMAN, JOCELYN GLORIA ALONSO (PT)
Entity Type:Individual
Prefix:
First Name:JOCELYN GLORIA
Middle Name:ALONSO
Last Name:RUIZ DE GUZMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 EASTCHESTER RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2328
Mailing Address - Country:US
Mailing Address - Phone:718-518-1133
Mailing Address - Fax:718-518-1244
Practice Address - Street 1:1894 EASTCHESTER RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2328
Practice Address - Country:US
Practice Address - Phone:718-518-1133
Practice Address - Fax:718-518-1244
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10550-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01267110 / 02324014Medicaid
NYQN3011 / Q1WCE1Medicare ID - Type UnspecifiedINDIV & GROUP NO.