| Guadalupe Mc Llc | |
|
18220 Midway Rd Dallas TX 75287-4901 | |
| (469) 606-0753 | |
| (469) 606-0753 |
| Full Name | Guadalupe Mc Llc |
|---|---|
| Speciality | Pediatrics |
| Location | 18220 Midway Rd, Dallas, Texas |
| Authorized Official Name and Position | Marcial Oquendo Rincon (MD (OWNER)) |
| Authorized Official Contact | 4696060753 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Guadalupe Mc Llc 14951 Dallas Pkwy Ste 190 Dallas TX 75254-6894 Ph: (469) 606-0753 | Guadalupe Mc Llc 18220 Midway Rd Dallas TX 75287-4901 Ph: (469) 606-0753 |
| NPI Number | 1437720257 |
|---|---|
| Provider Enumeration Date | 07/02/2021 |
| Last Update Date | 08/26/2021 |
| Medicare PECOS PAC ID | 6002218765 |
|---|---|
| Medicare Enrollment ID | O20210719000078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437720257 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | Marcial Andres Oquendo Rincon |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1821482886 PECOS PAC ID: 1355636002 Enrollment ID: I20160820000016 |
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