C V Guillermo Jr A Professional Medical Corp | |
4912 Highway 1 Raceland LA 70394 | |
(985) 532-5092 | |
(985) 532-8044 |
Full Name | C V Guillermo Jr A Professional Medical Corp |
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Speciality | General Practice |
Location | 4912 Highway 1, Raceland, Louisiana |
Authorized Official Name and Position | Claudio V Guillermo (PRESIDENT) |
Authorized Official Contact | 9855325092 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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C V Guillermo Jr A Professional Medical Corp Po Box 390 Raceland LA 70394 Ph: (985) 532-5092 | C V Guillermo Jr A Professional Medical Corp 4912 Highway 1 Raceland LA 70394 Ph: (985) 532-5092 |
NPI Number | 1417085143 |
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Provider Enumeration Date | 03/02/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1417085143 | NPI | - | NPPES |
1574214481 | Other | LA | BLUE CROSS |
1124087 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | 03719R (Louisiana) | Primary |
Physiofit Physical Therapy, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 120 White Rose Dr, Raceland, LA 70394 Phone: 985-532-9662 Fax: 985-532-3942 | |