Provider Demographics
NPI:1851381305
Name:PICO-ALONSO, GUILLERMO (MD)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:PICO-ALONSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 CALLE WILSON
Mailing Address - Street 2:SUITE 101, THE LITTLE TOWER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-2363
Mailing Address - Country:US
Mailing Address - Phone:787-728-2560
Mailing Address - Fax:787-728-2595
Practice Address - Street 1:1473 CALLE WILSON
Practice Address - Street 2:SUITE 101, THE LITTLE TOWER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2363
Practice Address - Country:US
Practice Address - Phone:787-728-2560
Practice Address - Fax:787-728-2595
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4642207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-5768OtherTRIPLE S, INC.
PR68381OtherCRUZ AZUL
PR601908OtherMEDICARE Y MUCHO MAS
PR8000539OtherHUMANA
PR2-5768Medicare ID - Type Unspecified
PRE15319Medicare UPIN