Provider Demographics
NPI:1184098238
Name:GUZMAN-HUESCA & PEREZ LLC
Entity type:Organization
Organization Name:GUZMAN-HUESCA & PEREZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZMAN-HUESCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-405-3525
Mailing Address - Street 1:3501 HEALTH CENTER BLVD
Mailing Address - Street 2:SUITE 2160
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-8127
Mailing Address - Country:US
Mailing Address - Phone:239-948-4470
Mailing Address - Fax:239-948-0933
Practice Address - Street 1:3501 HEALTH CENTER BLVD
Practice Address - Street 2:SUITE 2160
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-8127
Practice Address - Country:US
Practice Address - Phone:239-948-4470
Practice Address - Fax:239-948-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-72957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty