| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
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