Provider Demographics
NPI:1073632188
Name:GUILLERMO URUETA PEDIATRICS PA
Entity Type:Organization
Organization Name:GUILLERMO URUETA PEDIATRICS PA
Other - Org Name:KIDSCORNER PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:AUGUSTO
Authorized Official - Last Name:URUETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-773-7662
Mailing Address - Street 1:2198 E GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-5076
Mailing Address - Country:US
Mailing Address - Phone:830-773-7662
Mailing Address - Fax:830-773-7664
Practice Address - Street 1:2198 E GARRISON ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-5076
Practice Address - Country:US
Practice Address - Phone:830-773-7662
Practice Address - Fax:830-773-7664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
E01008299OtherDPS NUMBER
TXK6379OtherSTAE MEDICAL LICENSE
TX179181601Medicaid