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General NPI Number Information
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NPI Number | 1821220518
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Entity Type | Organization
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Legal Business Name | G. ANDRES QUICENO,M.D., P.A.
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 08/14/2009
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Provider Practice Location Address
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Address Line | 8230 WALNUT HILL LN SUITE 614
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City | DALLAS
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State | TX
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Zip | 75231-4482
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Country | US
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Telephone | 469-916-4906
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Fax | 469-916-0681
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Provider Business Mailing Address
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Address Line | 8230 WALNUT HILL LN SUITE 614
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City | DALLAS
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State | TX
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Zip | 75231-4482
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Country | US
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Telephone | 469-916-4906
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Fax | 469-916-0681
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Authorized Official
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Title or Position | OWNER
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Name | DR. GUILLERMO ANDRES QUICENO
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Credential | MD
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Telephone | 469-916-4906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | L2571
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License Number State | TX
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