Provider Demographics
NPI:1679210439
Name:GUILLERMO, MARIA TERESA ISIDRO
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:ISIDRO
Last Name:GUILLERMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIATERESA
Other - Middle Name:ISIDRO
Other - Last Name:GUILLERMO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8019 N MACARTHUR BLVD APT 1073
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-6150
Mailing Address - Country:US
Mailing Address - Phone:425-426-7860
Mailing Address - Fax:
Practice Address - Street 1:8019 N MACARTHUR BLVD APT 1073
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-6150
Practice Address - Country:US
Practice Address - Phone:206-853-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076976363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily