Provider Demographics
NPI:1821056102
Name:GUEL-VALDIVIA, VERONICA (MD)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:GUEL-VALDIVIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SPRINGWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3111
Mailing Address - Country:US
Mailing Address - Phone:361-576-2222
Mailing Address - Fax:361-580-4108
Practice Address - Street 1:102 SPRINGWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3111
Practice Address - Country:US
Practice Address - Phone:361-576-2222
Practice Address - Fax:361-580-4108
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5349207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157896502Medicaid
TX8J2010OtherBCBS
TX8B7567OtherBLUE CROSS
TX7043457OtherAETNA
TX157896501Medicaid
TX157896501Medicaid
TXP0052668Medicare PIN
TX7043457OtherAETNA
TX8A9236Medicare PIN