Individual
GUILLERMO GUILLEN BASTIDAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SURGICAL ASSISTANT
Contact information
Practice address
19015 S JODI RD STE H, MOKENA, IL 60448-8534
(866) 787-4452
Mailing address
1926 W WINONA ST APT GRD, CHICAGO, IL 60640-2676
(980) 441-9013
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
238.000761
IL
Other
Enumeration date
10/31/2022
Last updated
10/31/2022
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