Provider Demographics
NPI:1376589580
Name:ANGEL DE LA GUARDIA
Entity Type:Organization
Organization Name:ANGEL DE LA GUARDIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:COTA/L
Authorized Official - Phone:956-584-3196
Mailing Address - Street 1:1721 E GRIFFIN PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3103
Mailing Address - Country:US
Mailing Address - Phone:956-584-3196
Mailing Address - Fax:956-584-3187
Practice Address - Street 1:1721 E GRIFFIN PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3103
Practice Address - Country:US
Practice Address - Phone:956-584-3196
Practice Address - Fax:956-584-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health