Basic Information
| Provider Information | |||||||||
| NPI: | 1902866387 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUARDIA GONZALES | ||||||||
| FirstName: | GUILLERMO | ||||||||
| MiddleName: | MANUEL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GUARDIA | ||||||||
| OtherFirstName: | GUILLERMO | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2100 W CENTRAL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195375111 | ||||||||
| FaxNumber: | 4195375131 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 W CENTRAL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436063834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195375111 | ||||||||
| FaxNumber: | 4195375131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 02/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 35095361 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 000000671824 | 01 | OH | ANTHEM | OTHER | 06929 | 01 | OH | PARAMOUNT | OTHER | P00863907 | 01 | OH | MEDICARE - RR | OTHER |