MEDICARE: LIZ GUILLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1801765425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZ GUILLEN

Provider Business Mailing Address
First Line	:	125 W 228TH ST APT 1F
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-6644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 WALLACE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-9215
Country	:	US
Telephone Number	:	718-325-6593
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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Directions to “ LIZ GUILLEN ” Practice Location

Language	Start Address	Practice Location

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