Provider Demographics
NPI:1649961814
Name:ROSADO-GUAJARDO, SANDRA MARIA
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARIA
Last Name:ROSADO-GUAJARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 CRESTMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-1634
Mailing Address - Country:US
Mailing Address - Phone:940-390-6929
Mailing Address - Fax:
Practice Address - Street 1:4141 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1506
Practice Address - Country:US
Practice Address - Phone:972-316-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1027530208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation