Provider Demographics
NPI:1518943828
Name:RAMOS-GUZOM, MARIELOU (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARIELOU
Middle Name:
Last Name:RAMOS-GUZOM
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 1:6035 AIRLINE DR
Mailing Address - Street 2:STE 1
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-4240
Mailing Address - Country:US
Mailing Address - Phone:713-694-2808
Mailing Address - Fax:713-694-2833
Practice Address - Street 1:6035 AIRLINE DR
Practice Address - Street 2:STE 1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-4240
Practice Address - Country:US
Practice Address - Phone:713-694-2808
Practice Address - Fax:713-694-2833
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG7143OtherTL#
TX092665102Medicaid
TX760454735OtherTAX ID #
TXHX31OtherBLUE CROSS BLUE SHIELD
TX092665101Medicaid
TX092665102Medicaid