Provider Demographics
NPI:1417043167
Name:OLIVOS, GUILLERMO OLGUIN (MD)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:OLGUIN
Last Name:OLIVOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13 HILLSIDE RD
Mailing Address - Street 2:UNIT F
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-7792
Mailing Address - Country:US
Mailing Address - Phone:301-982-0834
Mailing Address - Fax:240-777-3226
Practice Address - Street 1:2424 REEDIE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-4624
Practice Address - Country:US
Practice Address - Phone:240-777-3209
Practice Address - Fax:240-777-3226
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDDO93982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDO9398OtherMEDICAL LICENSE