=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801480546
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA GUILLEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2021
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2520 E PACHECO BLVD
-----------------------------------------------------
City | LOS BANOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93635-9403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-664-4000
-----------------------------------------------------
Fax | 559-675-5224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3433 W SHAW AVE STE 102
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93711-3229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-558-4051
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 66659
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------