Provider Demographics
NPI:1265919526
Name:GUZMAN, KHALILA A (PA)
Entity type:Individual
Prefix:
First Name:KHALILA
Middle Name:A
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:930 TALON DR STE 1
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1962
Practice Address - Country:US
Practice Address - Phone:618-726-1080
Practice Address - Fax:618-726-1081
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110006305363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical