Healthcare Provider Details

I. General information

NPI: 1144426230
Provider Name (Legal Business Name): ALBERTO A GUARDIOLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 AVE HOSTOS PR-2 STE 1
MAYAGUEZ PR
00682-6326
US

IV. Provider business mailing address

2625 AVE HOSTOS STE 1
MAYAGUEZ PR
00682-6326
US

V. Phone/Fax

Practice location:
  • Phone: 787-476-0333
  • Fax: 787-476-0332
Mailing address:
  • Phone: 787-476-0333
  • Fax: 787-476-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number16801
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD434861
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number16801
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: