Healthcare Provider Details

I. General information

NPI: 1447245121
Provider Name (Legal Business Name): ARMANDO J GUARDIOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DE DIEGO 102 ESTE
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

DE DIEGO 102 ESTE
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-832-4386
  • Fax: 787-805-6110
Mailing address:
  • Phone: 787-832-4386
  • Fax: 787-805-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5723
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: