Provider Demographics
NPI:1588951115
Name:DE GUZMAN, PAUL QUINTO (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:QUINTO
Last Name:DE GUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3972 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-8160
Mailing Address - Country:US
Mailing Address - Phone:718-293-2626
Mailing Address - Fax:718-293-2627
Practice Address - Street 1:3972 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8160
Practice Address - Country:US
Practice Address - Phone:718-293-2626
Practice Address - Fax:718-293-2627
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003816207R00000X
NY276180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03507513Medicaid
NY03507513Medicaid