Provider Demographics
NPI:1710077649
Name:RIVERA-GUZMAN, GRACIELLA (PA)
Entity Type:Individual
Prefix:MS
First Name:GRACIELLA
Middle Name:
Last Name:RIVERA-GUZMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5590 WEST 20 AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33015
Mailing Address - Country:US
Mailing Address - Phone:305-827-3303
Mailing Address - Fax:305-556-3372
Practice Address - Street 1:5590 WEST 20 AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015
Practice Address - Country:US
Practice Address - Phone:305-827-3303
Practice Address - Fax:305-556-3372
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical