Provider Demographics
NPI:1972088367
Name:GUILLEN, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:GUILLEN
Suffix:
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 1:20850 SW 87TH AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-7405
Mailing Address - Country:US
Mailing Address - Phone:786-366-9024
Mailing Address - Fax:
Practice Address - Street 1:20850 SW 87TH AVE APT 208
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-7405
Practice Address - Country:US
Practice Address - Phone:786-366-9024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management