Provider Demographics
NPI:1902088636
Name:GUARIN-NIETO, ESGAR E (MD)
Entity Type:Individual
Prefix:
First Name:ESGAR
Middle Name:E
Last Name:GUARIN-NIETO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ESGAR
Other - Middle Name:
Other - Last Name:GUARIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5191 MAPLE DR STE L
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-8455
Mailing Address - Country:US
Mailing Address - Phone:515-603-2140
Mailing Address - Fax:
Practice Address - Street 1:311 3RD AVE SE STE 106
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1536
Practice Address - Country:US
Practice Address - Phone:515-603-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012004800207Q00000X
RIMD 13032207QA0505X, 207VX0000X, 208000000X
MDP20838390200000X
RIMD13032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO776B00006Medicare UPIN