Provider Demographics
NPI:1881459659
Name:GUILLEN, JOAQUIN (CRNA)
Entity type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:DR
Other - First Name:JOAQUIN
Other - Middle Name:
Other - Last Name:GUILLEN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:1100 ANAQUITAS ST APT 33
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-2202
Mailing Address - Country:US
Mailing Address - Phone:956-363-5461
Mailing Address - Fax:
Practice Address - Street 1:101 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1847
Practice Address - Country:US
Practice Address - Phone:956-632-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1153887367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered