Provider Demographics
NPI:1235313636
Name:GUILLAUME, MARIE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GUILLAUME
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 1:320 W TEMPLE ST FL 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3217
Mailing Address - Country:US
Mailing Address - Phone:213-974-0368
Mailing Address - Fax:213-699-4741
Practice Address - Street 1:320 W TEMPLE ST FL 9
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3217
Practice Address - Country:US
Practice Address - Phone:213-974-0368
Practice Address - Fax:213-699-4741
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171M00000XOtherCASE MANAGER