Provider Demographics
NPI:1811550742
Name:GUAJARDO SANT, ISABELLA (MD)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:GUAJARDO SANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BURNETT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2908
Mailing Address - Country:US
Mailing Address - Phone:870-425-9120
Mailing Address - Fax:
Practice Address - Street 1:901 BURNETT DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2908
Practice Address - Country:US
Practice Address - Phone:912-087-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA180845208600000X
390200000X
ARE-18123208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program