Provider Demographics
NPI:1740288141
Name:DE LA GUARDIA, ALBERTO ENRIQUE
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:ENRIQUE
Last Name:DE LA GUARDIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1815
Mailing Address - Country:US
Mailing Address - Phone:361-882-6868
Mailing Address - Fax:361-882-7878
Practice Address - Street 1:2601 HOSPITAL BLVD
Practice Address - Street 2:SUITE 216
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-1815
Practice Address - Country:US
Practice Address - Phone:361-882-6868
Practice Address - Fax:361-882-7878
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5598207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP0001468Medicaid
TXB22152Medicare UPIN
TXP0001468Medicaid