Provider Demographics
NPI:1730996430
Name:GUILLEN, ENRIA
Entity type:Individual
Prefix:
First Name:ENRIA
Middle Name:
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 1:54 CROOKED OAK LN
Mailing Address - Street 2:
Mailing Address - City:DELRAY
Mailing Address - State:WV
Mailing Address - Zip Code:26714-1400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:54 CROOKED OAK LN
Practice Address - Street 2:
Practice Address - City:DELRAY
Practice Address - State:WV
Practice Address - Zip Code:26714-1400
Practice Address - Country:US
Practice Address - Phone:571-541-0342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant