Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 64013 | CT |
NPI | 1083713416 |
---|---|
Provider Name | Raul J. Guzman |
First Address | New Haven, CT 06520-8062 |
Second Address | New Haven, CT 06510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 30/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G56596 | (02) |