Provider Demographics
NPI:1679895106
Name:GUILLOTEAU, JOSE MARIE
Entity Type:Individual
Prefix:MS
First Name:JOSE
Middle Name:MARIE
Last Name:GUILLOTEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 DELMAR LOOP
Mailing Address - Street 2:APT 7A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1614
Mailing Address - Country:US
Mailing Address - Phone:347-295-0817
Mailing Address - Fax:
Practice Address - Street 1:1285 DELMAR LOOP
Practice Address - Street 2:APT 7A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-1614
Practice Address - Country:US
Practice Address - Phone:347-295-0817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221465164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse