Provider Demographics
NPI:1013666320
Name:FONCERRADA ORTEGA, GUILLERMO (MD, MMS)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:
Last Name:FONCERRADA ORTEGA
Suffix:
Gender:M
Credentials:MD, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9152
Mailing Address - Country:US
Mailing Address - Phone:956-352-5100
Mailing Address - Fax:956-352-3237
Practice Address - Street 1:5501 MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9152
Practice Address - Country:US
Practice Address - Phone:956-352-5100
Practice Address - Fax:956-352-3237
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty