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NPI Code Detail

MEDICARE: RYAN RAFAEL GUAJARDO

MEDICARE:   RYAN RAFAEL GUAJARDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program45766TX

General Provider Information

NPI Number : 1114850500
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN RAFAEL GUAJARDO
Provider Business Mailing Address
First Line : 141 HARRIGAN CT APT 3
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78209-6235
Country : US
Telephone Number : 956-572-1250
Fax Number :
Provider Business Practice Location Address
First Line : 141 HARRIGAN CT APT 3
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78209-6235
Country : US
Telephone Number : 956-572-1250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2026
Last Update Date : 06/04/2026

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Directions to “ RYAN RAFAEL GUAJARDO ” Practice Location

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