Provider Demographics
NPI:1679625909
Name:CIRUGIA ORAL Y MAXILOFACIAL CLA CSP
Entity type:Organization
Organization Name:CIRUGIA ORAL Y MAXILOFACIAL CLA CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-756-5300
Mailing Address - Street 1:SUITE 503 #400 FD AVE ROOSEVELT
Mailing Address - Street 2:CLINICA LAS AMERICAS
Mailing Address - City:HATO REY
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-756-5300
Mailing Address - Fax:
Practice Address - Street 1:SUITE 503 #400 FD AVE ROOSEVELT
Practice Address - Street 2:CLINICA LAS AMERICAS
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-756-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR722261QS0112X
PR1699261QS0112X
PR2590261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1710095351OtherNPI
PR1942232871OtherNPI
PR1811003700OtherNPI