Provider Demographics
NPI:1699836049
Name:GUZMAN, VICTORIA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12448 SW 127TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6596
Mailing Address - Country:US
Mailing Address - Phone:305-255-5980
Mailing Address - Fax:305-255-9766
Practice Address - Street 1:12448 SW 127TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6596
Practice Address - Country:US
Practice Address - Phone:305-255-5980
Practice Address - Fax:305-255-9766
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2936235Z00000X
FLSA 2936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886589200Medicaid