Provider Demographics
NPI:1902866387
Name:GUARDIA GONZALES, GUILLERMO MANUEL (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:MANUEL
Last Name:GUARDIA GONZALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GUILLERMO
Other - Middle Name:M
Other - Last Name:GUARDIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2100 W CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3834
Mailing Address - Country:US
Mailing Address - Phone:419-537-5111
Mailing Address - Fax:419-537-5131
Practice Address - Street 1:2100 W CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3834
Practice Address - Country:US
Practice Address - Phone:419-537-5111
Practice Address - Fax:419-537-5131
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35095361207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06929OtherPARAMOUNT
OHP00863907OtherMEDICARE - RR
OH000000671824OtherANTHEM
OH000000671824OtherANTHEM