MEDICARE: DR. MARIO F GUILLEN MD

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	207R00000X	Internal Medicine Physician	ME84093	FL
2	208VP0000X	Pain Medicine Physician	ME 84093	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952345324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO F GUILLEN MD

Provider Business Mailing Address
First Line	:	10115 FOREST HILL BLVD
Second Line	:	SUITE 104
City	:	WELLINGTON
State	:	FL
Zip	:	33414-3105
Country	:	US
Telephone Number	:	561-793-1117
Fax Number	:	561-793-1762

Provider Business Practice Location Address
First Line	:	10115 FOREST HILL BLVD
Second Line	:	SUITE 104
City	:	WELLINGTON
State	:	FL
Zip	:	33414-3105
Country	:	US
Telephone Number	:	561-793-1117
Fax Number	:	561-793-1762

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	09/15/2011

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Directions to “ DR. MARIO F GUILLEN MD” Practice Location

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