Provider Demographics
NPI:1437579802
Name:HEARD, GUILLERMO (NP)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:HEARD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 E CALTON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3988
Mailing Address - Country:US
Mailing Address - Phone:956-728-8255
Mailing Address - Fax:956-728-0400
Practice Address - Street 1:702 E CALTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3988
Practice Address - Country:US
Practice Address - Phone:956-728-8255
Practice Address - Fax:956-728-0400
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX728586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT0182337OtherTEXAS CONTROLLED SUBSTANCE
TX728586OtherSTATE LICENSE
TXMH2815528OtherDEA