Provider Demographics
NPI:1811201502
Name:GUZMAN, ADA SONIA (RPT)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:SONIA
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CARAZO ST.COND. REGENCY APARTMENT
Mailing Address - Street 2:15A APARTMENT
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-633-8187
Mailing Address - Fax:
Practice Address - Street 1:155 CARAZO ST.COND. REGENCY APARTMENT
Practice Address - Street 2:1504 APARTMENT
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971
Practice Address - Country:US
Practice Address - Phone:787-633-8187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRRPT 224390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program