Provider Demographics
NPI:1902030869
Name:LARES-GUIA, JOSE MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MIGUEL
Last Name:LARES-GUIA
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 1:84 GROVE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3566
Mailing Address - Country:US
Mailing Address - Phone:646-429-5555
Mailing Address - Fax:678-553-1274
Practice Address - Street 1:84 GROVE ST APT 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3566
Practice Address - Country:US
Practice Address - Phone:646-429-5555
Practice Address - Fax:678-553-1274
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249492208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03161662Medicaid
A300029680Medicare PIN