Provider Demographics
NPI:1225188766
Name:MADRID GUZMAN, ALFONSO ALBERTO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFONSO
Middle Name:ALBERTO
Last Name:MADRID GUZMAN
Suffix:JR
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:PO BOX 195601
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5601
Mailing Address - Country:US
Mailing Address - Phone:787-790-7269
Mailing Address - Fax:787-720-8133
Practice Address - Street 1:42 CARAZO ST
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-790-7269
Practice Address - Fax:787-720-8133
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7238174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0028547Medicare UPIN