Provider Demographics
NPI:1184003840
Name:GUAIQUIL, PATRICIO (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIO
Middle Name:
Last Name:GUAIQUIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10225 AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978-1500
Mailing Address - Country:US
Mailing Address - Phone:619-660-6003
Mailing Address - Fax:
Practice Address - Street 1:10225 AUSTIN DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1500
Practice Address - Country:US
Practice Address - Phone:619-660-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10261400207Q00000X
390200000X
CA20A17418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty