Individual
DAVID GUADALUPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA-C
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-3076
(864) 455-4135
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
3514
GA
367H00000X
Anesthesiologist Assistant
Primary
80
SC
367H00000X
Anesthesiologist Assistant
AA83
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000942A
—
GA
05
—
100000942E
—
GA
05
—
100000942F
—
GA
05
—
PENDING
—
SC
Enumeration date
10/04/2005
Last updated
08/04/2021
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