33D1093198 CLIA NUMBER - R GUILLEN, MD PC

Laboratory Demographics

CLIA Number: 33D1093198

Facility Name: R GUILLEN, MD PC

Facility Address:
800 GRAND CONCOURSE - FRONT OFFICE #5
BRONX, NY
ZIP 10451
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Facility Phone Number: 718 401-2300

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1467612499

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	33D1093198
LAB Type	Physician Office
Facility Name	R GUILLEN, MD PC
Street	800 GRAND CONCOURSE - FRONT OFFICE #5
City	BRONX
State	NY
ZIP	10451
Phone	718 401-2300
CertificateType	4
CertificateEffectiveDate	12/12/2022
CertificateExpirationDate	12/11/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024