Provider Demographics
NPI:1588086292
Name:GUADALUPE, ALEXANDER
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:GUADALUPE
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:#128 AVE. ROOSVELT MARGINAL SUR
Mailing Address - Street 2:HATO REY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-0000
Mailing Address - Country:US
Mailing Address - Phone:787-449-5514
Mailing Address - Fax:787-788-3688
Practice Address - Street 1:128 AVE ROOSEVELT
Practice Address - Street 2:HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-2740
Practice Address - Country:US
Practice Address - Phone:787-449-5514
Practice Address - Fax:787-788-3688
Is Sole Proprietor?:No
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional