Provider Demographics
NPI:1992314058
Name:GUZMAN OTERO, JUAN MIGUEL
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:MIGUEL
Last Name:GUZMAN OTERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1522
Mailing Address - Country:US
Mailing Address - Phone:786-266-1652
Mailing Address - Fax:305-266-1653
Practice Address - Street 1:7811 CORAL WAY STE 138
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6540
Practice Address - Country:US
Practice Address - Phone:786-266-1652
Practice Address - Fax:786-266-1653
Is Sole Proprietor?:No
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily