Provider Demographics
NPI:1235366923
Name:GUILLOT, JOHN-PAUL M (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN-PAUL
Middle Name:M
Last Name:GUILLOT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10051 ROCK MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-2785
Mailing Address - Country:US
Mailing Address - Phone:718-226-1873
Mailing Address - Fax:
Practice Address - Street 1:10051 ROCK MEADOW RD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:CA
Practice Address - Zip Code:92040-2785
Practice Address - Country:US
Practice Address - Phone:515-988-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5008213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery