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Organization
C V GUILLERMO JR A PROFESSIONAL MEDICAL CORP
Active
Organization
C V GUILLERMO JR A PROFESSIONAL MEDICAL CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLAUDIO V GUILLERMO JR. (PRESIDENT)
(985) 532-5092
Entity
Organization
Contact information
Practice address
4912 HIGHWAY 1, RACELAND, LA 70394
(985) 532-5092
(985) 532-8044
Mailing address
PO BOX 390, RACELAND, LA 70394
(985) 532-5092
(985) 532-8044
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
03719R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124087
—
LA
01
—
1574214481
BLUE CROSS
LA
Enumeration date
03/02/2007
Last updated
08/22/2020
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