Provider Demographics
NPI:1922381920
Name:GUANAJUATO, FELIX III (FNP)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:GUANAJUATO
Suffix:III
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HIGHWAY 305 SOUTH-B1200
Mailing Address - Street 2:
Mailing Address - City:MCCAMEY
Mailing Address - State:TX
Mailing Address - Zip Code:79752-1200
Mailing Address - Country:US
Mailing Address - Phone:432-652-4010
Mailing Address - Fax:432-652-4013
Practice Address - Street 1:2500 HIGHWAY 305 SOUTH
Practice Address - Street 2:
Practice Address - City:MCCAMEY
Practice Address - State:TX
Practice Address - Zip Code:79752
Practice Address - Country:US
Practice Address - Phone:432-652-4010
Practice Address - Fax:432-652-4013
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669812363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF0911153OtherCERTIFICATION
TX669812OtherLICENSE
TXAP120879OtherLICENSE
TXMG2561896OtherDEA
TX87V601OtherBCBS
TXF0911153OtherCERTICATION
TX87V600OtherBCBS
TX453835Medicare PIN
TX00L82SMedicare PIN