Provider Demographics
NPI:1649000761
Name:GUZMAN, EDGAR RENE
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:RENE
Last Name:GUZMAN
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 1:50 FOUNTAIN PLZ STE 1400
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-2215
Mailing Address - Country:US
Mailing Address - Phone:213-526-4600
Mailing Address - Fax:
Practice Address - Street 1:50 FOUNTAIN PLZ STE 1400
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2215
Practice Address - Country:US
Practice Address - Phone:213-526-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00077025246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy