Healthcare Provider Details

I. General information

NPI: 1699330654
Provider Name (Legal Business Name): ALBERTO SANTIAGO GUAJARDO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 DIXIELAND RD STE 8
HARLINGEN TX
78552-3314
US

IV. Provider business mailing address

3302 BOCA CHICA BLVD
BROWNSVILLE TX
78521-5193
US

V. Phone/Fax

Practice location:
  • Phone: 956-423-7000
  • Fax:
Mailing address:
  • Phone: 956-982-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberPA12769
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA12769
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: