Basic Information
| Provider Information | |||||||||
| NPI: | 1154475796 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUARTUCHE | ||||||||
| FirstName: | VIOLA | ||||||||
| MiddleName: | H | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 331580 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784631580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618887752 | ||||||||
| FaxNumber: | 3618887424 | ||||||||
| Practice Location | |||||||||
| Address1: | 1326 SANTA FE ST | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784042214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3618887752 | ||||||||
| FaxNumber: | 3618887424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 12/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225000000X | CFM01094 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Orthotic Fitter |
ID Information
| ID | Type | State | Issuer | Description | 0863524-01 | 05 | TX | MEDICAID |