Healthcare Provider Details

I. General information

NPI: 1417043167
Provider Name (Legal Business Name): GUILLERMO OLGUIN OLIVOS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 REEDIE DR SUITE 300
WHEATON MD
20902-4624
US

IV. Provider business mailing address

13 HILLSIDE RD UNIT F
GREENBELT MD
20770-7792
US

V. Phone/Fax

Practice location:
  • Phone: 240-777-3209
  • Fax: 240-777-3226
Mailing address:
  • Phone: 301-982-0834
  • Fax: 240-777-3226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO9398
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: