Provider Demographics
NPI:1194820993
Name:GUADALUPE, RUBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:GUADALUPE
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:URB. SAN ANTONIO
Mailing Address - Street 2:A-2 CARR 924
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791
Mailing Address - Country:US
Mailing Address - Phone:787-850-4820
Mailing Address - Fax:787-850-4765
Practice Address - Street 1:URB. SAN ANTONIO
Practice Address - Street 2:A-2 CARR 924
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-4820
Practice Address - Fax:787-850-4765
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12021207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4299OtherAMERICAN HEALTH
PR601560OtherMMM
PR9070125OtherHUMANA HEALTH
PR061368OtherCRUZ AZUL
PR209565OtherPREFERED HEALTH
PR20186OtherSSS
PR5879OtherIMC
PR9070125OtherHUMANA HEALTH
PR209565OtherPREFERED HEALTH