Provider Demographics
NPI:1780818237
Name:GUEVARA-MASTRANGELO, JEANNE G (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:G
Last Name:GUEVARA-MASTRANGELO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CALLE SANTA CRUZ #66
Mailing Address - Street 2:INSTITUTO SAN PABLO SUITE 507
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7041
Mailing Address - Country:US
Mailing Address - Phone:787-740-2011
Mailing Address - Fax:787-740-8377
Practice Address - Street 1:CALLE SANTA CRUZ #66
Practice Address - Street 2:INSTITUTO SAN PABLO SUITE 507
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7041
Practice Address - Country:US
Practice Address - Phone:787-740-2011
Practice Address - Fax:787-740-8377
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR182192084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
HG953AMedicare PIN