Provider Demographics
NPI:1225478258
Name:GUILEZ, CONCEPCION JR (MT)
Entity Type:Individual
Prefix:MR
First Name:CONCEPCION
Middle Name:
Last Name:GUILEZ
Suffix:JR
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 52ND ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-2502
Mailing Address - Country:US
Mailing Address - Phone:505-804-9849
Mailing Address - Fax:
Practice Address - Street 1:220 52ND ST SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-2502
Practice Address - Country:US
Practice Address - Phone:505-804-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7396174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist