Provider Demographics
NPI:1467003020
Name:GUADALUPE, CARMEN S
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:S
Last Name:GUADALUPE
Suffix:
Gender:F
Credentials:
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 370071
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-0071
Mailing Address - Country:US
Mailing Address - Phone:787-424-5369
Mailing Address - Fax:
Practice Address - Street 1:URB COLINAS DE GUAVATE
Practice Address - Street 2:CARR 184 KM 39.1
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-424-5369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider