Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | P0392 | TX |
NPI | 1144403387 |
---|---|
Provider Name | Dr. Gustavo E. Guajardo Salinas |
First Address | Dallas, TX 75391-1230 |
Second Address | San Antonio, TX 78258-4890 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2007 |
Last Update Date | 16/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
375784102 | (05) | TX |
E-8210 | MED. LICENSE (01) | AR |