Provider Demographics
NPI:1386120210
Name:GUILLEN, MARCOS (CHEMICAL DEPENDENCY)
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:GUILLEN
Suffix:
Gender:M
Credentials:CHEMICAL DEPENDENCY
Other - Prefix:
Other - First Name:MARCOS
Other - Middle Name:
Other - Last Name:GUILLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDC
Mailing Address - Street 1:1317 DEL NORTE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8368
Mailing Address - Country:US
Mailing Address - Phone:805-991-7561
Mailing Address - Fax:
Practice Address - Street 1:1317 DEL NORTE RD STE 209
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8485
Practice Address - Country:US
Practice Address - Phone:805-991-7561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC052380518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)