1386120210 NPI number — MARCOS GUILLEN CHEMICAL DEPENDENCY

Table of content: MARCOS GUILLEN CHEMICAL DEPENDENCY (NPI 1386120210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386120210 NPI number — MARCOS GUILLEN CHEMICAL DEPENDENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUILLEN
Provider First Name:
MARCOS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CHEMICAL DEPENDENCY
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUILLEN
Provider Other First Name:
MARCOS
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CDC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1386120210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 DEL NORTE RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93010-8368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-991-7561
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1317 DEL NORTE RD STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93010-8485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-991-7561
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  C052380518 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com