1205179165 NPI number — DELMAR R GUZMAN LSA

Table of content: DELMAR R GUZMAN LSA (NPI 1205179165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205179165 NPI number — DELMAR R GUZMAN LSA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUZMAN
Provider First Name:
DELMAR
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205179165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 SUGAR CREEK CENTER BLVD STE 618
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77478-3540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
326-554-1418
Provider Business Mailing Address Fax Number:
713-457-5188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SUGAR CREEK BLVD
Provider Second Line Business Practice Location Address:
STE 618
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-655-4141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246ZC0007X , with the licence number:  19157857 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SA00457 . This is a "TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8QN036 . This is a "BCBS - BLUE STAR SURGICAL ASSISTANTS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8QN119 . This is a "BCBS - UNIVERSAL SURGICAL MSO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8QN120 . This is a "BCBS - UNIVERSAL SURGICAL ASSISTANTS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8QN038 . This is a "BCBS - XCITE SURGICAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com