Basic Information
Provider Information | |||||||||
NPI: | 1710937552 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GUZMAN | ||||||||
FirstName: | ROSEMARIE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PA-C | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BRUMBAUGH | ||||||||
OtherFirstName: | ROSEMARIE | ||||||||
OtherMiddleName: | GUZMAN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PA-C | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1700 WEST LOOP SOUTH | ||||||||
Address2: | SUITE 400B | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770273005 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7132772222 | ||||||||
FaxNumber: | 2107030934 | ||||||||
Practice Location | |||||||||
Address1: | 155 LOUETTA CROSSING | ||||||||
Address2: |   | ||||||||
City: | SPRING | ||||||||
State: | TX | ||||||||
PostalCode: | 77373 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2815280278 | ||||||||
FaxNumber: | 2815282975 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/11/2006 | ||||||||
LastUpdateDate: | 10/08/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA02971 | TX | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 8N8718 | 01 | TX | BCBSTX - HOSP BASED | OTHER | 8N9797 | 01 | TX | BCBSTX - OFFICE BASED | OTHER |