Provider Demographics
NPI:1225729049
Name:GUILLEN, ALFREDO S (DO)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:S
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 NW 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2504
Mailing Address - Country:US
Mailing Address - Phone:305-819-2313
Mailing Address - Fax:305-819-3546
Practice Address - Street 1:9300 NW 77TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2504
Practice Address - Country:US
Practice Address - Phone:305-819-2313
Practice Address - Fax:305-819-3546
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO1095156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician