Provider Demographics
NPI:1164413894
Name:GUADALUPE, MYRIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:
Last Name:GUADALUPE
Suffix:
Gender:F
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:PO BOX 799
Mailing Address - Street 2:
Mailing Address - City:RIO BLANCO
Mailing Address - State:PR
Mailing Address - Zip Code:00744-0799
Mailing Address - Country:US
Mailing Address - Phone:787-256-6300
Mailing Address - Fax:787-256-6300
Practice Address - Street 1:185 ST. KM.11.1 LOMAS COLES
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-0729
Practice Address - Country:US
Practice Address - Phone:787-256-6300
Practice Address - Fax:787-256-6300
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15992208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-4370Medicare PIN
PRI-52652Medicare UPIN