# GUILLERMO FAMILY MEDICAL CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538460480
- **Authorized official:** DR. ANDRES J GUILLERMO M.D. (OWNER/PROVIDER)
- **Authorized official phone:** (337) 460-7688

## Contact information

- **Practice address:** 301 S WASHINGTON ST, SUITE A, DERIDDER, LA 70634-4861
- **Practice address phone:** (337) 460-7688
- **Practice address fax:** (337) 460-7691
- **Mailing address:** 301 S WASHINGTON ST, SUITE A, DERIDDER, LA 70634-4861
- **Mailing address phone:** (337) 460-7688
- **Mailing address fax:** (337) 460-7691

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD.203910 | LA | Yes |

## Other

- **Enumeration date:** 11/09/2010
- **Last updated:** 11/09/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1005690 | — | LA |