Provider Demographics
NPI:1356637227
Name:GUADARRAMA, DELISA EVA (MD)
Entity Type:Individual
Prefix:DR
First Name:DELISA
Middle Name:EVA
Last Name:GUADARRAMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1614
Mailing Address - Country:US
Mailing Address - Phone:956-362-8290
Mailing Address - Fax:956-362-8295
Practice Address - Street 1:2821 MICHAELANGELO DR STE 204
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1423
Practice Address - Country:US
Practice Address - Phone:956-362-8290
Practice Address - Fax:956-362-8295
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ76932084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3652737-03Medicaid
TXH08MN08301OtherBCBS