Healthcare Provider Details

I. General information

NPI: 1770831257
Provider Name (Legal Business Name): GUILLERMO JAIME B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 SW 4TH ST
MIAMI FL
33174-2073
US

IV. Provider business mailing address

155 S MIAMI AVE
MIAMI FL
33130-1617
US

V. Phone/Fax

Practice location:
  • Phone: 305-794-1910
  • Fax:
Mailing address:
  • Phone: 305-779-9600
  • Fax: 305-779-9601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: