Provider Demographics
NPI:1881459659
Name:GUILLEN, JOAQUIN (CRNA)
Entity type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:DR
Other - First Name:JOAQUIN
Other - Middle Name:
Other - Last Name:GUILLEN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:800-994-0371
Mailing Address - Fax:254-215-9722
Practice Address - Street 1:1901 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1814
Practice Address - Country:US
Practice Address - Phone:800-994-0371
Practice Address - Fax:254-215-9722
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1153887367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered