Provider Demographics
NPI:1255390084
Name:SAURINA, GUILLERMO R
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:R
Last Name:SAURINA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GUILLERMO
Other - Middle Name:R
Other - Last Name:SAURINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MSC
Mailing Address - Street 1:2301 N ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2620
Mailing Address - Country:US
Mailing Address - Phone:229-245-0666
Mailing Address - Fax:
Practice Address - Street 1:2301 N ASHLEY ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2620
Practice Address - Country:US
Practice Address - Phone:229-245-0666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA48570207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000876565AMedicaid
FL262103700Medicaid
GA11BDRWFMedicare PIN
GAG89185Medicare UPIN