Provider Demographics
NPI:1871454264
Name:GUSMAN, AMPARO R
Entity type:Individual
Prefix:
First Name:AMPARO
Middle Name:R
Last Name:GUSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18501 PINES BLVD STE 347
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1414
Mailing Address - Country:US
Mailing Address - Phone:786-890-8574
Mailing Address - Fax:
Practice Address - Street 1:18501 PINES BLVD STE 347
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1414
Practice Address - Country:US
Practice Address - Phone:786-890-8574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20-127062106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician