Provider Demographics
NPI:1114088671
Name:GUILLAUME, DARREN WILLIAM (PA-C, CS)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:WILLIAM
Last Name:GUILLAUME
Suffix:
Gender:M
Credentials:PA-C, CS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:22558 CANYON RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5414
Mailing Address - Country:US
Mailing Address - Phone:510-461-0756
Mailing Address - Fax:510-733-9464
Practice Address - Street 1:5700 TELEGRAPH AVE STE 100
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1710
Practice Address - Country:US
Practice Address - Phone:510-594-9411
Practice Address - Fax:510-594-2275
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14010363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA140100OtherCMS
ZZZ04812ZOtherCMS