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NPI Code Detail

MEDICARE: JUAN ANTONIO GUAJARDO

MEDICARE: JUAN ANTONIO GUAJARDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor69757TX

General Provider Information

NPI Number : 1114382611
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN ANTONIO GUAJARDO
Provider Business Mailing Address
First Line : 1700 COVEMEADOW DR
Second Line :
City : ARLINGTON
State : TX
Zip : 76012-5407
Country : US
Telephone Number : 469-966-7734
Fax Number :
Provider Business Practice Location Address
First Line : 1700 COVEMEADOW DR
Second Line :
City : ARLINGTON
State : TX
Zip : 76012-5407
Country : US
Telephone Number : 469-966-7734
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2015
Last Update Date : 07/02/2025

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Directions to “ JUAN ANTONIO GUAJARDO ” Practice Location

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