Provider Demographics
NPI:1295133577
Name:GUZMAN, ADRIANA (RD)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4V2 CALLE 214
Mailing Address - Street 2:COLINAS DE FAIR VIEW
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-8245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4V2 CALLE 214
Practice Address - Street 2:COLINAS DE FAIR VIEW
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-8245
Practice Address - Country:US
Practice Address - Phone:787-391-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1045603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1045603Medicaid
PR1045603Medicare PIN
PR1045603Medicare UPIN
PR1045603Medicare Oscar/Certification