Provider Demographics
NPI:1174881429
Name:INGUANZO, GABRIEL
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:INGUANZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 HWY 359
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4742
Mailing Address - Country:US
Mailing Address - Phone:956-220-4432
Mailing Address - Fax:956-727-4901
Practice Address - Street 1:4401 HWY 359
Practice Address - Street 2:SUITE 5
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4742
Practice Address - Country:US
Practice Address - Phone:956-220-4432
Practice Address - Fax:956-727-4901
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10006033416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB1390Medicare PIN