1780390831 NPI number — MRS. LESHMARIE DEMORIZI GUZMAN

Table of content: MRS. LESHMARIE DEMORIZI GUZMAN (NPI 1780390831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780390831 NPI number — MRS. LESHMARIE DEMORIZI GUZMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMORIZI GUZMAN
Provider First Name:
LESHMARIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1780390831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
URB. LOS COLOBOS PARK CALLE ALMENDRO 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAROLINA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00987
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
939-241-8777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
#463 AVE. JUAN PONCE DE LEON/PLAZA AEELA SUITE 712
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
939-205-2345
Provider Business Practice Location Address Fax Number:
787-946-5549
Provider Enumeration Date:
01/23/2023

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: 103TC1900X , with the licence number:  7527 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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