Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MT215273 | PA |
N | 208000000X | Pediatrician | MT215273 | PA |
N | 2080P0205X | Pediatric Endocrinologist | MT215273 | PA |
NPI | 1649764515 |
---|---|
Provider Name | Herodes Guzman |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2018 |
Last Update Date | 21/06/2021 |