Provider Demographics
NPI:1275122491
Name:GUILLORY, ANGEL (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W ARBUTUS ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-2102
Mailing Address - Country:US
Mailing Address - Phone:562-236-6515
Mailing Address - Fax:
Practice Address - Street 1:324 W ARBUTUS ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-2102
Practice Address - Country:US
Practice Address - Phone:562-236-6515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24332246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy