Healthcare Provider Details

I. General information

NPI: 1982911236
Provider Name (Legal Business Name): EDWIN A GUOBADIA LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

IV. Provider business mailing address

7021 OCONNOR ST
ARLINGTON TX
76002-4006
US

V. Phone/Fax

Practice location:
  • Phone: 713-791-1414
  • Fax:
Mailing address:
  • Phone: 631-838-1239
  • Fax: 817-472-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number52001
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: