Provider Demographics
NPI:1710620042
Name:COLUMBIE, GUILLERMO ENRIQUE II
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:ENRIQUE
Last Name:COLUMBIE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 MIAMI LAKES DR STE 348
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2738
Mailing Address - Country:US
Mailing Address - Phone:305-321-4509
Mailing Address - Fax:
Practice Address - Street 1:6625 MIAMI LAKES DR STE 348
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2738
Practice Address - Country:US
Practice Address - Phone:305-321-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor