Provider Demographics
NPI:1831154418
Name:GUILLERMO, GEMMA (MD)
Entity type:Individual
Prefix:DR
First Name:GEMMA
Middle Name:
Last Name:GUILLERMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2290 VERA AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-1346
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:170 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:1EAST, SEQUOIA HOSPITAL
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2799
Practice Address - Country:US
Practice Address - Phone:650-367-5559
Practice Address - Fax:650-368-3754
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA610662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3967836Medicaid
CA3967836Medicaid
CA00A610661Medicare PIN
CA92M291Medicare ID - Type Unspecified