Provider Demographics
NPI:1154475796
Name:GUARTUCHE, VIOLA H
Entity type:Individual
Prefix:
First Name:VIOLA
Middle Name:H
Last Name:GUARTUCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 331580
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-1580
Mailing Address - Country:US
Mailing Address - Phone:361-888-7752
Mailing Address - Fax:361-888-7424
Practice Address - Street 1:1326 SANTA FE ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2214
Practice Address - Country:US
Practice Address - Phone:361-888-7752
Practice Address - Fax:361-888-7424
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCFM01094225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0863524-01Medicaid