Provider Demographics
NPI:1033512868
Name:GUAJARDO, MARIETTA BERMUDEZ (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:BERMUDEZ
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MARIETTA
Other - Middle Name:MENESES
Other - Last Name:BERMUDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7913 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6511
Mailing Address - Country:US
Mailing Address - Phone:210-698-9841
Mailing Address - Fax:210-698-9863
Practice Address - Street 1:7913 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6511
Practice Address - Country:US
Practice Address - Phone:210-698-9841
Practice Address - Fax:210-698-9863
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95005262363L00000X
TXAP126286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner