Provider Demographics
NPI:1043234941
Name:ROSARIO GUARDIOLA, REINALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:REINALDO
Middle Name:
Last Name:ROSARIO GUARDIOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 AVE MUNOZ RIVERA
Mailing Address - Street 2:SUITE 3170
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4257
Mailing Address - Country:US
Mailing Address - Phone:787-765-2305
Mailing Address - Fax:787-764-1359
Practice Address - Street 1:652 AVE MUNOZ RIVERA
Practice Address - Street 2:SUITE 3170
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4257
Practice Address - Country:US
Practice Address - Phone:787-765-2305
Practice Address - Fax:787-764-1359
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4262207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE08241Medicare UPIN