Provider Demographics
NPI:1851393060
Name:GUILLEN, JULIO C JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:C
Last Name:GUILLEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2235 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-6369
Mailing Address - Country:US
Mailing Address - Phone:504-393-2775
Mailing Address - Fax:504-393-2744
Practice Address - Street 1:3801 GENERAL DEGAULLE DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8207
Practice Address - Country:US
Practice Address - Phone:504-362-2829
Practice Address - Fax:504-362-2866
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1572462Medicaid
LAH48120Medicare UPIN
LA1572462Medicaid