Provider Demographics
NPI:1801311469
Name:GUZMAN, YAMIZARET
Entity type:Individual
Prefix:
First Name:YAMIZARET
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 W CULLERTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2701
Mailing Address - Country:US
Mailing Address - Phone:312-217-1023
Mailing Address - Fax:
Practice Address - Street 1:2310 W ROOSEVELT RD FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1131
Practice Address - Country:US
Practice Address - Phone:312-655-7991
Practice Address - Fax:312-236-5384
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health