Provider Demographics
NPI:1649384140
Name:GUILLEN, EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:PROF
Other - First Name:EDUARDO
Other - Middle Name:
Other - Last Name:GUILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:802 E UNIVERSITY DR STE B
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3632
Mailing Address - Country:US
Mailing Address - Phone:956-287-7500
Mailing Address - Fax:956-287-0121
Practice Address - Street 1:802 E UNIVERSITY DR STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3632
Practice Address - Country:US
Practice Address - Phone:956-287-7500
Practice Address - Fax:956-287-0121
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0793208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129535405Medicaid