Provider Demographics
NPI:1568006005
Name:GUILLIEN, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:GUILLIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 13TH AVE NE STE 109
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1007
Mailing Address - Country:US
Mailing Address - Phone:612-378-1050
Mailing Address - Fax:612-378-1051
Practice Address - Street 1:34 13TH AVE NE STE 109
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1007
Practice Address - Country:US
Practice Address - Phone:612-378-1050
Practice Address - Fax:612-378-1051
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist