Provider Demographics
NPI:1538293139
Name:GUAJARDO, CESAR (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:GUAJARDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 W COLONY PL
Mailing Address - Street 2:STE160
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-5577
Mailing Address - Country:US
Mailing Address - Phone:919-489-2878
Mailing Address - Fax:919-489-2878
Practice Address - Street 1:20 W COLONY PL
Practice Address - Street 2:STE160
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-5577
Practice Address - Country:US
Practice Address - Phone:919-489-2878
Practice Address - Fax:919-489-2878
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC150892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8937857Medicaid
NC8937857Medicaid