Provider Demographics
NPI:1437720257
Name:GUADALUPE MC LLC
Entity Type:Organization
Organization Name:GUADALUPE MC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD (OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:MARCIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:OQUENDO RINCON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-606-0753
Mailing Address - Street 1:14951 DALLAS PKWY STE 190
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-6894
Mailing Address - Country:US
Mailing Address - Phone:469-606-0753
Mailing Address - Fax:469-606-0753
Practice Address - Street 1:18220 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-4901
Practice Address - Country:US
Practice Address - Phone:469-606-0753
Practice Address - Fax:469-606-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty