Gina Guillaume
Family Medicine in Portland, OR. Individual provider (NPI-1).
NPI number1649705682
StatusActive
Last updated in NPPESJan 25, 2024
Details
- NPI
- 1649705682
- Entity type
- Individual (NPI-1)
- Name
- Gina Guillaume
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 27, 2017
- Certification date
- Jan 25, 2024
- Last updated
- Jan 25, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | MD205674 | OR | Yes |
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – |
Practice location
10373 Ne Hancock St Ste 125Portland, OR 97220-3873
Phone 503-253-6754 · Fax 503-253-8020
Mailing address
Po Box 8459Portland, OR 97207-8459
Phone 503-238-0769 · Fax 503-764-9042
Other practice locations
1403 West Lomita Blvd Suite 200
Harbor City, CA 90710
Harbor City, CA 90710
Phone 310-534-7600
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