Provider Demographics
NPI:1972334977
Name:GUZMAN MERCADO, GABRIEL JESUS (DC)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JESUS
Last Name:GUZMAN MERCADO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TAFT CT STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5577
Mailing Address - Country:US
Mailing Address - Phone:301-279-9009
Mailing Address - Fax:
Practice Address - Street 1:4 TAFT CT STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5577
Practice Address - Country:US
Practice Address - Phone:301-279-9009
Practice Address - Fax:301-279-9008
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD390200000X
MDS04234111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program