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General NPI Number Information
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NPI Number | 1467097659
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Entity Type | Individual
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Provider Name | GUADALUPE MEXICANO MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/12/2019
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 17580 I H 45 S
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City | CONROE
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State | TX
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Zip | 77384-4972
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Country | US
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Telephone | 936-267-7841
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Fax |
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Provider Business Mailing Address
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Address Line | 17580 I H 45 S
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City | CONROE
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State | TX
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Zip | 77384-4972
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Country | US
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Telephone |
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT7181
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License Number State | TX
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