Provider Demographics
NPI:1265662001
Name:GUALBERTO, RUBEN SUZON (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:SUZON
Last Name:GUALBERTO
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 1:100 S GARNSEY AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2191
Mailing Address - Country:US
Mailing Address - Phone:661-428-6617
Mailing Address - Fax:
Practice Address - Street 1:100 S GARNSEY AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2191
Practice Address - Country:US
Practice Address - Phone:661-428-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32356207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine