Provider Demographics
NPI:1982018404
Name:GUAJARDO, REBECA (CPO, LPO)
Entity Type:Individual
Prefix:
First Name:REBECA
Middle Name:
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:CPO, LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11381 MEADOWGLEN LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-6664
Mailing Address - Country:US
Mailing Address - Phone:281-589-2040
Mailing Address - Fax:281-589-2058
Practice Address - Street 1:11381 MEADOWGLEN LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-6664
Practice Address - Country:US
Practice Address - Phone:281-589-2040
Practice Address - Fax:281-589-2058
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49-12156222Z00000X
TXLPO49224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist