Provider Demographics
NPI:1295372092
Name:GUILLERMO CHIRINOS, MANUEL JESUS (SA-C)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:JESUS
Last Name:GUILLERMO CHIRINOS
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 NE 170TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1755
Mailing Address - Country:US
Mailing Address - Phone:239-222-7940
Mailing Address - Fax:
Practice Address - Street 1:75 NE 170TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-1755
Practice Address - Country:US
Practice Address - Phone:239-222-7940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-30
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19-491246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty