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General NPI Number Information
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NPI Number | 1417085143
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Entity Type | Organization
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Legal Business Name | C V GUILLERMO JR A PROFESSIONAL MEDICAL CORP
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4912 HIGHWAY 1
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City | RACELAND
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State | LA
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Zip | 70394
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Country | US
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Telephone | 985-532-5092
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Fax | 985-532-8044
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Provider Business Mailing Address
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Address Line | PO BOX 390
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City | RACELAND
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State | LA
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Zip | 70394
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Country | US
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Telephone | 985-532-5092
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Fax | 985-532-8044
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLAUDIO V GUILLERMO JR.
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Credential |
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Telephone | 985-532-5092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 03719R
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License Number State | LA
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