Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 34923R | PR |
NPI | 1003378977 |
---|---|
Provider Name | Dr. Oscar Andres Guillama |
First Address | Camuy, PR 00627-9650 |
Second Address | Houston, TX 77030-3498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2019 |
Last Update Date | 25/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BP10073826 | TEXAS MEDICAL BOARD (01) | TX |