Provider Demographics
NPI:1770831257
Name:JAIME, GUILLERMO (BA)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:JAIME
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 S MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1617
Mailing Address - Country:US
Mailing Address - Phone:305-779-9600
Mailing Address - Fax:305-779-9601
Practice Address - Street 1:9401 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2073
Practice Address - Country:US
Practice Address - Phone:305-794-1910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical