Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | K1828 | TX |
Y | 2080P0203X | Pediatric Critical Care Doctor | K1828 | TX |
NPI | 1083689780 |
---|---|
Provider Name | Karen Guillory |
First Address | San Antonio, TX 78229-3311 |
Second Address | San Antonio, TX 78229-3902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 20/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105683007 | (05) | TX |
105683008 | CSN (01) | TX |
8EA040 | BCBS (01) | TX |