1205159019 NPI number — DR. MARIA MAGDALENA GUERRERO O.D.

Table of content: DR. MARIA MAGDALENA GUERRERO O.D. (NPI 1205159019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205159019 NPI number — DR. MARIA MAGDALENA GUERRERO O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUERRERO
Provider First Name:
MARIA
Provider Middle Name:
MAGDALENA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205159019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 2 BOX 13307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AGUAS BUENAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00703-9819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-924-4500
Provider Business Mailing Address Fax Number:
787-924-7777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 156 KM 49.4
Provider Second Line Business Practice Location Address:
BO. SUMIDERO
Provider Business Practice Location Address City Name:
AGUAS BUENAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00703-9819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-924-7777
Provider Business Practice Location Address Fax Number:
787-924-7777
Provider Enumeration Date:
03/08/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  352 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FD519Z . This is a "PTAN" identifier . This identifiers is of the category "OTHER".