Provider Demographics
NPI:1497744072
Name:GUERRERO-RODRIGUEZ, LIDIA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:M
Last Name:GUERRERO-RODRIGUEZ
Suffix:
Gender:F
Credentials:DMD
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 29736
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0736
Mailing Address - Country:US
Mailing Address - Phone:787-755-4347
Mailing Address - Fax:787-283-7440
Practice Address - Street 1:521 ANTONIO VARCARCEL
Practice Address - Street 2:URB. REPARTO AMERICA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3337
Practice Address - Country:US
Practice Address - Phone:787-755-4347
Practice Address - Fax:787-250-8450
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2074122300000X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR02074OtherPROFESSIONAL LICENSE NUM