Healthcare Provider Details

I. General information

NPI: 1922154376
Provider Name (Legal Business Name): SADIASEPT GUILLONT JUARBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 CALLE ENCARNACION CAPARRA HEIGTHS
SAN JUAN PR
00920-4743
US

IV. Provider business mailing address

1611 CALLE ENCARNACION CAPARRA HEIGHTS
SAN JUAN PR
00920-4743
US

V. Phone/Fax

Practice location:
  • Phone: 787-622-3054
  • Fax:
Mailing address:
  • Phone: 787-622-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14587
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number14587
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number14587
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number14587
License Number StatePR
# 5
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number14587
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number14587
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number14587
License Number StatePR
# 8
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number14587
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: