Provider Demographics
NPI:1255890778
Name:GUZMAN HERNANDEZ, EDGAR JOSE
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:JOSE
Last Name:GUZMAN HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND MEDICAL CENTER PLAZA
Mailing Address - Street 2:1051 CALLE 3SE APT 112
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-638-9203
Mailing Address - Fax:
Practice Address - Street 1:COND MEDICAL CENTER PLAZA
Practice Address - Street 2:1051 CALLE 3SE APT 112
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-638-9203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program