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General NPI Number Information
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NPI Number | 1245519917
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Entity Type | Individual
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Provider Name | LUIS ANDRES GUAJARDO FNP-C
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Gender | Male
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 130 S CENTRAL EXPY
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City | MCKINNEY
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State | TX
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Zip | 75070-3742
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Country | US
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Telephone | 972-548-5356
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Fax | 972-548-5357
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Provider Business Mailing Address
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Address Line | 130 S CENTRAL EXPY
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City | MCKINNEY
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State | TX
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Zip | 75070-3742
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Country | US
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Telephone | 972-548-5356
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Fax | 972-548-5357
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | 745060
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License Number State | TX
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