Provider Demographics
NPI:1205159019
Name:GUERRERO, MARIA MAGDALENA (OD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MAGDALENA
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 13307
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-9819
Mailing Address - Country:US
Mailing Address - Phone:787-924-4500
Mailing Address - Fax:787-924-7777
Practice Address - Street 1:CARR 156 KM 49.4
Practice Address - Street 2:BO. SUMIDERO
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-9819
Practice Address - Country:US
Practice Address - Phone:787-924-7777
Practice Address - Fax:787-924-7777
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FD519ZOtherPTAN