Provider Demographics
NPI:1700833548
Name:GUZMAN, GUILLERMO ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:ANTONIO
Last Name:GUZMAN
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 1:7113 SAN PEDRO AVE
Mailing Address - Street 2:# 316
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6219
Mailing Address - Country:US
Mailing Address - Phone:210-745-0084
Mailing Address - Fax:210-745-0139
Practice Address - Street 1:4120 CLOVER LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-3708
Practice Address - Country:US
Practice Address - Phone:817-223-8498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF66962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114900703Medicaid
TXB23223Medicare UPIN
TX89W653Medicare ID - Type Unspecified