Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP132054 | TX |
NPI | 1013466390 |
---|---|
Provider Name | Mr. Homero Guaderrama |
First Address | El Paso, TX 79907-6635 |
Second Address | El Paso, TX 79907-6635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2016 |
Last Update Date | 27/09/2016 |