Provider Demographics
NPI:1154083186
Name:GUILLEN, KARL LOUIS (AAS)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:LOUIS
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 W CALLE ALTA LOMA
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-7099
Mailing Address - Country:US
Mailing Address - Phone:520-870-8324
Mailing Address - Fax:520-297-5355
Practice Address - Street 1:740 W CALLE ALTA LOMA
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-7099
Practice Address - Country:US
Practice Address - Phone:520-870-8324
Practice Address - Fax:520-297-5355
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
77614AZOther77614AZ