MEDICARE: DR. GUALBERTO GUERRERO-MANZANO 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	208D00000X	General Practice Physician	11467	PR

General Provider Information

NPI Number	:	1215147616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUALBERTO GUERRERO-MANZANO M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 20621
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00928-0621
Country	:	US
Telephone Number	:	787-761-4932
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 CALLE SAN JULIAN
Second Line	:	URB. SAGRADO CORAZON
City	:	SAN JUAN
State	:	PR
Zip	:	00926-4233
Country	:	US
Telephone Number	:	787-761-4932
Fax Number	:

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	01/07/2016

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