1558477919 NPI number — NESTOR E GUZMAN DMD

Table of content: NESTOR E GUZMAN DMD (NPI 1558477919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558477919 NPI number — NESTOR E GUZMAN DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUZMAN
Provider First Name:
NESTOR
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1558477919
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8200 W SUNRISE BLVD
Provider Second Line Business Mailing Address:
SUITE A1
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33322-5426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-336-8478
Provider Business Mailing Address Fax Number:
954-693-8775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 W SUNRISE BLVD
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33322-5426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-336-8478
Provider Business Practice Location Address Fax Number:
954-693-8775
Provider Enumeration Date:
08/21/2006

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: 1223G0001X , with the licence number:  DN16737 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 005718900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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