Healthcare Provider Details

I. General information

NPI: 1861173684
Provider Name (Legal Business Name): LUIS ANTONIO GUILLEN JR. PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9702 BALL ST
SAN ANTONIO TX
78217-3724
US

IV. Provider business mailing address

9702 BALL ST
SAN ANTONIO TX
78217-3724
US

V. Phone/Fax

Practice location:
  • Phone: 956-605-8471
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number728468
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: