Provider Demographics
NPI:1881744704
Name:GUAJARDO, JUAN G (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:G
Last Name:GUAJARDO
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 1:100B E ALTON GLOOR BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3376
Mailing Address - Country:US
Mailing Address - Phone:956-350-4821
Mailing Address - Fax:956-350-6718
Practice Address - Street 1:100B E ALTON GLOOR BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3376
Practice Address - Country:US
Practice Address - Phone:956-350-4821
Practice Address - Fax:956-350-6718
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9714207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180384301Medicaid
TX180384302Medicaid
TX180384301Medicaid
TXI49980Medicare UPIN
TX8F9346Medicare PIN