Provider Demographics
NPI:1023759461
Name:LURBE GUILLEN, OLIN FIDEL
Entity type:Individual
Prefix:
First Name:OLIN
Middle Name:FIDEL
Last Name:LURBE 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 1:1 SW 129TH AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1716
Mailing Address - Country:US
Mailing Address - Phone:954-430-9898
Mailing Address - Fax:
Practice Address - Street 1:1 SW 129TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1716
Practice Address - Country:US
Practice Address - Phone:954-430-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily