Provider Demographics
NPI:1821220518
Name:G. ANDRES QUICENO,M.D., P.A.
Entity Type:Organization
Organization Name:G. ANDRES QUICENO,M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:QUICENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-916-4906
Mailing Address - Street 1:8230 WALNUT HILL LN
Mailing Address - Street 2:SUITE 614
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4482
Mailing Address - Country:US
Mailing Address - Phone:469-916-4906
Mailing Address - Fax:469-916-0681
Practice Address - Street 1:8230 WALNUT HILL LN
Practice Address - Street 2:SUITE 614
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4482
Practice Address - Country:US
Practice Address - Phone:469-916-4906
Practice Address - Fax:469-916-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2571207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty