Provider Demographics
NPI:1598952038
Name:GUAJARDO CLINIC PA
Entity type:Organization
Organization Name:GUAJARDO CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ROLANDO
Authorized Official - Last Name:GUAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:713-928-6255
Mailing Address - Street 1:6901 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77011
Mailing Address - Country:US
Mailing Address - Phone:713-928-6255
Mailing Address - Fax:713-928-6245
Practice Address - Street 1:6901 CANAL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77011
Practice Address - Country:US
Practice Address - Phone:713-928-6255
Practice Address - Fax:713-928-6245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8294111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF004333OtherFACILITY LICENSE