Provider Demographics
NPI:1881443703
Name:HERNANDEZ GUZMAN, ALBA REBECCA (MD)
Entity type:Individual
Prefix:
First Name:ALBA
Middle Name:REBECCA
Last Name:HERNANDEZ GUZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE EMILIO APARICIO #32 ENS JULIETA
Mailing Address - Street 2:
Mailing Address - City:SANTO DOMINGO
Mailing Address - State:DISTRITO NACIONAL
Mailing Address - Zip Code:10130
Mailing Address - Country:DO
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3401 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5189
Practice Address - Country:US
Practice Address - Phone:800-836-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT230662207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology