Provider Demographics
NPI:1801215405
Name:GUADALUPE, ADA NELLIS
Entity type:Individual
Prefix:MRS
First Name:ADA
Middle Name:NELLIS
Last Name:GUADALUPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST. 5-2, #B-15 URB. MONTE BRISASV
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-996-7424
Mailing Address - Fax:787-860-7387
Practice Address - Street 1:ST. 5-2, URB. MONTE BRISASV
Practice Address - Street 2:#B-15
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-996-7424
Practice Address - Fax:787-860-7387
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR73591041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool