Provider Demographics
NPI:1598469330
Name:GUILLEN, CHILTON (ETC)
Entity Type:Individual
Prefix:MR
First Name:CHILTON
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 W OWENS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-2432
Mailing Address - Country:US
Mailing Address - Phone:805-264-3272
Mailing Address - Fax:
Practice Address - Street 1:1363 W OWENS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-2432
Practice Address - Country:US
Practice Address - Phone:805-264-3272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver