Provider Demographics
NPI:1588038244
Name:GUILLEN, JESSICA (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S MAIN ST
Mailing Address - Street 2:205
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90014-2009
Mailing Address - Country:US
Mailing Address - Phone:213-819-3912
Mailing Address - Fax:
Practice Address - Street 1:610 S MAIN ST
Practice Address - Street 2:205
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-2009
Practice Address - Country:US
Practice Address - Phone:213-819-3912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily