Provider Demographics
NPI:1558455741
Name:GUARINO, EDWARD(TED) JAMES (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD(TED)
Middle Name:JAMES
Last Name:GUARINO
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 1:2450 SAMARITAN DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3912
Mailing Address - Country:US
Mailing Address - Phone:408-356-4777
Mailing Address - Fax:408-356-4775
Practice Address - Street 1:2450 SAMARITAN DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3912
Practice Address - Country:US
Practice Address - Phone:408-356-4777
Practice Address - Fax:408-356-4775
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG632352084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF64096Medicare UPIN
CA00G632350Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID