Provider Demographics
NPI:1265789994
Name:GUZMAN, MIRIAM (MS ED)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10129 106TH ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2718
Mailing Address - Country:US
Mailing Address - Phone:347-768-1288
Mailing Address - Fax:
Practice Address - Street 1:10129 106TH ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2718
Practice Address - Country:US
Practice Address - Phone:347-768-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist