MEDICARE: EDWARD(TED) JAMES GUARINO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	G63235	CA

General Provider Information

NPI Number	:	1558455741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD(TED) JAMES GUARINO M.D.

Provider Business Mailing Address
First Line	:	2450 SAMARITAN DR
Second Line	:	SUITE 2
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3912
Country	:	US
Telephone Number	:	408-356-4777
Fax Number	:	408-356-4775

Provider Business Practice Location Address
First Line	:	2450 SAMARITAN DR
Second Line	:	SUITE 2
City	:	SAN JOSE
State	:	CA
Zip	:	95124-3912
Country	:	US
Telephone Number	:	408-356-4777
Fax Number	:	408-356-4775

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	05/06/2010

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