Provider Demographics
NPI:1578847059
Name:GUILLERMO, FELICE T
Entity Type:Individual
Prefix:
First Name:FELICE
Middle Name:T
Last Name:GUILLERMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FELICE
Other - Middle Name:T
Other - Last Name:GUITERMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:94-665 LOAA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1517
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:94-665 LOAA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1517
Practice Address - Country:US
Practice Address - Phone:808-677-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home