Provider Demographics
NPI:1811041825
Name:CUMBA GUERRERO, JOSE
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:CUMBA GUERRERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PALACIOS DEL RIO II
Mailing Address - Street 2:CALLE CIBUCO 766
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-5116
Mailing Address - Country:US
Mailing Address - Phone:787-390-0578
Mailing Address - Fax:
Practice Address - Street 1:PALACIOS DEL RIO II
Practice Address - Street 2:CALLE CIBUCO 766
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-390-0578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14079208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084362Medicare PIN