Provider Demographics
NPI:1558307082
Name:GUADALUPE, YADIRA C (RPT)
Entity Type:Individual
Prefix:MRS
First Name:YADIRA
Middle Name:C
Last Name:GUADALUPE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:D9 URB EL MAESTRO
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2704
Mailing Address - Country:US
Mailing Address - Phone:787-820-4776
Mailing Address - Fax:787-820-4776
Practice Address - Street 1:2 CALLE 2
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2338
Practice Address - Country:US
Practice Address - Phone:787-820-4776
Practice Address - Fax:787-820-4776
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84123Medicare ID - Type UnspecifiedPHYSICAL THERAPY