Provider Demographics
NPI:1467581322
Name:GUASP, GLENDA GRISSELLE (MD)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:GRISSELLE
Last Name:GUASP
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:CHABLIS 12
Mailing Address - Street 2:ESTANCIAS DE EL VERDE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:787-745-6278
Mailing Address - Fax:787-745-6278
Practice Address - Street 1:MUNOZ RIVERA
Practice Address - Street 2:NUM A1 PISO G
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726
Practice Address - Country:US
Practice Address - Phone:787-653-3434
Practice Address - Fax:787-745-6278
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12883208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics