Provider Demographics
NPI:1487004990
Name:GUARDERAS RIBADENEIRA, MATEO (MD)
Entity Type:Individual
Prefix:
First Name:MATEO
Middle Name:
Last Name:GUARDERAS RIBADENEIRA
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 1:1714 STATE HIGHWAY 22 W
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-2907
Mailing Address - Country:US
Mailing Address - Phone:479-477-3084
Mailing Address - Fax:479-477-3085
Practice Address - Street 1:1714 STATE HIGHWAY 22 W
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-2907
Practice Address - Country:US
Practice Address - Phone:479-477-3084
Practice Address - Fax:479-477-3085
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-15224208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery