Provider Demographics
NPI:1841571924
Name:J. GABRIEL GUAJARDO, MD, P.A.
Entity Type:Organization
Organization Name:J. GABRIEL GUAJARDO, MD, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-466-0243
Mailing Address - Street 1:100 E ALTON GLOOR BLVD
Mailing Address - Street 2:BLDG B, STE 130
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3328
Mailing Address - Country:US
Mailing Address - Phone:956-350-4821
Mailing Address - Fax:956-350-6718
Practice Address - Street 1:100 E ALTON GLOOR BLVD
Practice Address - Street 2:BLDG B, STE 130
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3328
Practice Address - Country:US
Practice Address - Phone:956-350-4821
Practice Address - Fax:956-350-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty