Provider Demographics
NPI:1861681504
Name:GUILLERMO, CLAUDIO VERDADERO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAUDIO
Middle Name:VERDADERO
Last Name:GUILLERMO
Suffix:JR
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:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:RACELAND
Mailing Address - State:LA
Mailing Address - Zip Code:70394-0390
Mailing Address - Country:US
Mailing Address - Phone:985-532-5092
Mailing Address - Fax:985-532-8044
Practice Address - Street 1:4912 HWY. 1
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394-0390
Practice Address - Country:US
Practice Address - Phone:985-532-5092
Practice Address - Fax:985-532-8044
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03719R208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1124087Medicaid
LAB62208Medicare UPIN
LA50149Medicare PIN