Provider Demographics
NPI:1922461789
Name:MEDRANO DEL ROSAL, GUILLERMO (MD)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:MEDRANO DEL ROSAL
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 1:5510-B PRESIDIO PARKWAY
Mailing Address - Street 2:SUITE 2205
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249
Mailing Address - Country:US
Mailing Address - Phone:210-874-3732
Mailing Address - Fax:210-874-3733
Practice Address - Street 1:5510-B PRESIDIO PARKWAY
Practice Address - Street 2:SUITE 2205
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249
Practice Address - Country:US
Practice Address - Phone:210-874-3732
Practice Address - Fax:210-874-3733
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD474934208600000X
282N00000X
TXT4977208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA34051792OtherLICENSE NUMBER