Healthcare Provider Details

I. General information

NPI: 1679400873
Provider Name (Legal Business Name): ROBERT GUILLEN JR. CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBI GUILLEN CMT

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W SAN RAFAEL DR APT 85
PALM SPRINGS CA
92262-1689
US

IV. Provider business mailing address

500 W SAN RAFAEL DR APT 85
PALM SPRINGS CA
92262-1689
US

V. Phone/Fax

Practice location:
  • Phone: 626-428-8402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number100219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: