Healthcare Provider Details

I. General information

NPI: 1831211416
Provider Name (Legal Business Name): ERICK GUILLORY P. A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 WILSHIRE BLVD SUITE 404
BEVERLY HILLS CA
90210-5424
US

IV. Provider business mailing address

8162 MANITOBA ST UNIT 305
PLAYA DEL REY CA
90293-8641
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-9171
  • Fax: 310-278-2058
Mailing address:
  • Phone: 310-482-1453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 13616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: