Provider Demographics
NPI:1528866209
Name:JOSE GUZMAN RDN LLC
Entity type:Organization
Organization Name:JOSE GUZMAN RDN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN NUTRITIONIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RDN, LD
Authorized Official - Phone:815-603-3305
Mailing Address - Street 1:1209 MOUNTAIN ROAD PL NE # 5906
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7845
Mailing Address - Country:US
Mailing Address - Phone:815-603-3305
Mailing Address - Fax:
Practice Address - Street 1:1209 MOUNTAIN ROAD PL NE # 5906
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7845
Practice Address - Country:US
Practice Address - Phone:815-603-3305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty