| Organization Name: | C V GUILLERMO JR A PROFESSIONAL MEDICAL CORP |
| NPI Number: | 1417085143 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CLAUDIO V GUILLERMO (PRESIDENT) |
| Mailing Address: | 4912 Highway 1 Raceland |
| State: | LA US |
| Postal Code: | 70394 |
| Phone Number: | 9855325092 |
| Fax Number: | 9855328044 |
| NPI Enumeration Date: | 03/02/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 03719R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |