Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP132916 | TX |
NPI | 1023540507 |
---|---|
Provider Name | Florenda De Guzman |
First Address | Odessa, TX 79762-7916 |
Second Address | Odessa, TX 79761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2017 |
Last Update Date | 03/04/2017 |