Provider Demographics
NPI:1639203409
Name:GUILLEN, FAUSTO D (MD)
Entity Type:Individual
Prefix:DR
First Name:FAUSTO
Middle Name:D
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LEVITOWN LAKE QUINTA SESION
Mailing Address - Street 2:BN 17 DR CATANO
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-261-4402
Mailing Address - Fax:
Practice Address - Street 1:LEVITOWN LAKE QUINTA SESION
Practice Address - Street 2:BN 17 DR CATANO
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-261-4402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR49722083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4972OtherPHYSICIAN LICENSE