Provider Demographics
NPI:1487443461
Name:GUILLEN, MARIA DE JESUS
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DE JESUS
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 1:20196 PURPLE SAGE RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8756
Mailing Address - Country:US
Mailing Address - Phone:208-440-6740
Mailing Address - Fax:
Practice Address - Street 1:20196 PURPLE SAGE RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-8756
Practice Address - Country:US
Practice Address - Phone:208-440-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCFH6200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health