Provider Demographics
NPI:1760493381
Name:GUERRA CARDONA, RUDDY ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:RUDDY
Middle Name:ANTONIO
Last Name:GUERRA CARDONA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1107
Mailing Address - Country:US
Mailing Address - Phone:787-884-5107
Mailing Address - Fax:787-884-0819
Practice Address - Street 1:EDIF MEDICO DR. PEDRO BLANCO LUGO
Practice Address - Street 2:SUITE 311
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-5107
Practice Address - Fax:787-884-0819
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR113082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F86960Medicare UPIN