Healthcare Provider Details

I. General information

NPI: 1124280110
Provider Name (Legal Business Name): GUAJARDO & RODRIGUEZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 WASHINGTON AVE STE A
HOUSTON TX
77007-5434
US

IV. Provider business mailing address

PO BOX 131285
HOUSTON TX
77219-1285
US

V. Phone/Fax

Practice location:
  • Phone: 713-457-5600
  • Fax: 713-457-5501
Mailing address:
  • Phone: 713-457-5600
  • Fax: 713-457-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number8823
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number8857
License Number StateTX

VIII. Authorized Official

Name: ROGELIO GABRIEL RODRIGUEZ
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 713-457-5600