Provider Demographics
NPI:1770807851
Name:DEMORIZI GUZMAN, LESLIE D (MS)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:DEMORIZI GUZMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ITURREGUI PLAZA
Mailing Address - Street 2:SUITE 216-B
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-701-2626
Mailing Address - Fax:787-768-8094
Practice Address - Street 1:ITURREGUI PLAZA 65 INFANTERIA
Practice Address - Street 2:SUITE 216-B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924
Practice Address - Country:US
Practice Address - Phone:787-701-2626
Practice Address - Fax:787-768-8094
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16526261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR16526OtherCLINICAL SOCIAL WORKER