Healthcare Provider Details

I. General information

NPI: 1073632188
Provider Name (Legal Business Name): GUILLERMO URUETA PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2198 E GARRISON ST
EAGLE PASS TX
78852-5076
US

IV. Provider business mailing address

2198 E GARRISON ST
EAGLE PASS TX
78852-5076
US

V. Phone/Fax

Practice location:
  • Phone: 830-773-7662
  • Fax: 830-773-7664
Mailing address:
  • Phone: 830-773-7662
  • Fax: 830-773-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GUILLERMO AUGUSTO URUETA
Title or Position: OWNER
Credential: M.D.
Phone: 830-773-7662