Provider Demographics
NPI:1407295066
Name:GUARDIA RULLAN, GIANNINA EMINEE (MD)
Entity Type:Individual
Prefix:MS
First Name:GIANNINA
Middle Name:EMINEE
Last Name:GUARDIA RULLAN
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 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:956-682-6146
Mailing Address - Fax:956-631-0441
Practice Address - Street 1:777 LOWNDES HILL RD BLDG 1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2101
Practice Address - Country:US
Practice Address - Phone:864-908-3530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4555207V00000X
PR19596207V00000X
390200000X
FLME149173207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program