Provider Demographics
NPI:1386382638
Name:GUILLEN, MIRIAM Y
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:Y
Last Name:GUILLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 APPALOOSA DR.
Mailing Address - Street 2:SUITE C 310
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063
Mailing Address - Country:US
Mailing Address - Phone:575-332-9086
Mailing Address - Fax:
Practice Address - Street 1:1580 APPALOOSA DR.
Practice Address - Street 2:SUITE C 310
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063
Practice Address - Country:US
Practice Address - Phone:575-332-9086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker