Provider Demographics
NPI:1609535368
Name:GUADALUPE, JOSE DANIEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:DANIEL
Last Name:GUADALUPE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EXT ESTANCIAS DEL MAYORAL 92
Mailing Address - Street 2:CALLE VINAZA
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766
Mailing Address - Country:US
Mailing Address - Phone:787-298-7921
Mailing Address - Fax:
Practice Address - Street 1:AVE. SAN CRISTOBAL
Practice Address - Street 2:LOTE 1 O 2
Practice Address - City:COTTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-365-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7170103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical