Healthcare Provider Details

I. General information

NPI: 1023091188
Provider Name (Legal Business Name): LEONEL ENRIQUE GUERRERO RODRIGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TORRE SAN PABLO DEL ESTE, SUITE 401 AVE. GENERAL VALERO # 410
FAJARDO PR
00738
US

IV. Provider business mailing address

20 AVE LUIS MUNOZ MARIN PMB 536 URB VILLA BLANCA
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-655-0505
  • Fax: 787-863-1212
Mailing address:
  • Phone: 787-308-5846
  • Fax: 787-860-0947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number14100
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: