Healthcare Provider Details

I. General information

NPI: 1669846754
Provider Name (Legal Business Name): JULIO C. GUILLEN, JR. MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 PALMER AVE
NEW ORLEANS LA
70118-6369
US

IV. Provider business mailing address

2235 PALMER AVE
NEW ORLEANS LA
70118-6369
US

V. Phone/Fax

Practice location:
  • Phone: 504-432-3207
  • Fax:
Mailing address:
  • Phone: 504-362-2829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.024214
License Number StateLA

VIII. Authorized Official

Name: JULIO C. GUILLEN
Title or Position: MD
Credential: MD
Phone: 504-432-3207