Healthcare Provider Details

I. General information

NPI: 1437579802
Provider Name (Legal Business Name): GUILLERMO HEARD NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E CALTON RD SUITE 101
LAREDO TX
78041-3988
US

IV. Provider business mailing address

702 E CALTON RD SUITE 101
LAREDO TX
78041-3988
US

V. Phone/Fax

Practice location:
  • Phone: 956-728-8255
  • Fax: 956-728-0400
Mailing address:
  • Phone: 956-728-8255
  • Fax: 956-728-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number728586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: