1427642362 NPI number — ADRIANA GUZMAN PA

Table of content: ADRIANA GUZMAN PA (NPI 1427642362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427642362 NPI number — ADRIANA GUZMAN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUZMAN
Provider First Name:
ADRIANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1427642362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 GAGE BLVD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99352-9532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-942-3627
Provider Business Mailing Address Fax Number:
509-627-2983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
888 SWIFT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
99-422-6485
Provider Business Practice Location Address Fax Number:
509-942-2812
Provider Enumeration Date:
02/22/2021

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: 363A00000X , with the licence number:  PA61334286 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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