Provider Demographics
NPI:1740032739
Name:GUZMAN, BRANDEIS ANGEL LEE
Entity type:Individual
Prefix:
First Name:BRANDEIS
Middle Name:ANGEL LEE
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 1:6000 TURKEY LAKE RD STE 144
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4200
Mailing Address - Country:US
Mailing Address - Phone:321-732-3723
Mailing Address - Fax:321-352-7168
Practice Address - Street 1:6000 TURKEY LAKE RD STE 144
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4200
Practice Address - Country:US
Practice Address - Phone:321-732-3723
Practice Address - Fax:321-352-7168
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician