Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFM01094 | TX |
NPI | 1154475796 |
---|---|
Provider Name | Viola H Guartuche |
First Address | Corpus Christi, TX 78463-1580 |
Second Address | Corpus Christi, TX 78404-2214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 03/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0863524-01 | (05) | TX |