Provider Demographics
NPI:1487004990
Name:GUARDERAS RIBADENEIRA, MATEO (MD)
Entity type:Individual
Prefix:
First Name:MATEO
Middle Name:
Last Name:GUARDERAS RIBADENEIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-3395
Mailing Address - Country:US
Mailing Address - Phone:799-682-3454
Mailing Address - Fax:479-890-7180
Practice Address - Street 1:101 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-3395
Practice Address - Country:US
Practice Address - Phone:479-968-2345
Practice Address - Fax:479-890-7180
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-15224208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery