Odon Martin Guillermo, D.O.

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

5115 Beach Channel Dr
Far Rockaway, NY 11691-1042

Phone

(718) 734-2000

NPI assigned

Apr 7, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Osteopathy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207526400000",
    "number": "1679746010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 745",
            "city": "UNIONDALE",
            "state": "NY",
            "postal_code": "115530745",
            "telephone_number": "949-888-1233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 BEACH CHANNEL DR",
            "city": "FAR ROCKAWAY",
            "state": "NY",
            "postal_code": "116911042",
            "telephone_number": "718-734-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILLERMO",
        "first_name": "ODON",
        "middle_name": "MARTIN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-07",
        "last_updated": "2008-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yongchul Gu, MD
• Erika Rubi Guadalupe
• Melanie Guadalupe, RN
• Jerusha Deepthi Gudapati, MD
• Pauline Guerrieri, LMHC
• Gupta Gastro Rockaway Office Based Surgery, P.C.
• Addisalem Belete Gurara, MD
• Iain Eduardo Peter Guy, DPM
• Clark D. Haber, MD
• Ayesha Habib

• Student in an Organized Health Care Education/Training Program in Far Rockaway, NY
• Providers in Far Rockaway, NY by specialty
• Student in an Organized Health Care Education/Training Program in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.