Provider Demographics
NPI:1174828719
Name:GUAJARDO, RODOLFO (PA-C)
Entity type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:
Last Name:GUAJARDO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:RUDY
Other - Middle Name:
Other - Last Name:GUAJARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2820 N BELT LINE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-9304
Mailing Address - Country:US
Mailing Address - Phone:972-288-6189
Mailing Address - Fax:972-698-7641
Practice Address - Street 1:2820 N BELT LINE RD STE 100
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:TX
Practice Address - Zip Code:75182-9304
Practice Address - Country:US
Practice Address - Phone:972-288-6189
Practice Address - Fax:972-698-7641
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07132363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA07132OtherTEXAS MEDICAL BOARD