Provider Demographics
NPI:1649766304
Name:GUERRERO GONZALEZ, MADELINE (MD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:GUERRERO GONZALEZ
Suffix:
Gender:F
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:URB QTAS DE HUMACAO
Mailing Address - Street 2:D15 CALLE C
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4222
Mailing Address - Country:US
Mailing Address - Phone:305-537-8377
Mailing Address - Fax:
Practice Address - Street 1:URB QTAS DE HUMACAO
Practice Address - Street 2:D15 CALLE C
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4222
Practice Address - Country:US
Practice Address - Phone:305-537-8377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR22316208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program