Provider Demographics
NPI:1588653570
Name:LANDRON GUARDIOLA, JOSE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:LANDRON GUARDIOLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:29 CALLE WASHINGTON
Mailing Address - Street 2:SUITE 501
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1510
Mailing Address - Country:US
Mailing Address - Phone:787-725-5955
Mailing Address - Fax:787-722-7847
Practice Address - Street 1:1451 AVENIDA ASHFORD
Practice Address - Street 2:RADIOLOGY DEPARTMENT FIRST FLOOR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1511
Practice Address - Country:US
Practice Address - Phone:787-725-5955
Practice Address - Fax:787-722-7847
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR66122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR98793OtherTRIPLE S
PR068544OtherCRUZ AZUL
PR98793OtherTRIPLE S
PR98793Medicare ID - Type Unspecified