Provider Demographics
NPI:1548210875
Name:GUAJARDO, PABLO (MD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
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 1:303 E QUINCY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1922
Mailing Address - Country:US
Mailing Address - Phone:210-922-0621
Mailing Address - Fax:210-927-1171
Practice Address - Street 1:303 E QUINCY
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1922
Practice Address - Country:US
Practice Address - Phone:210-922-0621
Practice Address - Fax:210-927-1171
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7415207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110652801Medicaid
TX8F23769Medicare PIN
TXB23165Medicare UPIN
TX110652801Medicaid