Provider Demographics
NPI:1831710383
Name:GUZMAN, VIVIANA (LND)
Entity type:Individual
Prefix:MRS
First Name:VIVIANA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:QUINTAS DE ALTAMIRA
Mailing Address - Street 2:1083 MONTE GUILARTE STREET
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-9851
Mailing Address - Country:US
Mailing Address - Phone:787-432-5097
Mailing Address - Fax:
Practice Address - Street 1:QUINTAS DE ALTAMIRA
Practice Address - Street 2:1083 MONTE GUILARTE STREET
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-9851
Practice Address - Country:US
Practice Address - Phone:787-432-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1166133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty