| Doctor Name: | EDNAGRACE GUILLEN |
| NPI Number: | 1114381936 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 95002989 |
| Business Practice Address: | 3050 Tweedy Blvd South Gate, CA - 90280 |
| Business Phone Number: | 3233570700 |
| Business Fax Number: | |
| Mailing Address: | 12727 Brian Ct, CERRITOS |
| State: | CA |
| Postal Code: | 907031117 |
| Phone Number: | 5628816545 |
| Fax Number: | |
| NPI Enumeration Date: | 04/07/2016 |
| NPI Last Update Date: | 04/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 95002989 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |