Individual
JOSE ENRIQUE GUILLEN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1715 CHILDERLEE LN NE, ATLANTA, GA 30329-2434
(503) 442-7307
Mailing address
7921 BERMEJO RD, FT WORTH, TX 76112-6144
(503) 442-7307
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1132245
TX
Other
Enumeration date
05/01/2016
Last updated
05/01/2016
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