Roberto Carlos Guillen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA207674 Issued in OR

Practice address

3896 Beverly Ave NE Ste 40
Salem, OR 97305-1374

Phone

(503) 588-0076

Fax

(503) 588-7578

NPI assigned

Jan 17, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: rguillen37810@yvfwc.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Four M Medical Mart a Medical Corporation

  • Occupational Medicine Physician
  • North Hollywood, CA
  • NPI 1447381736
  NPD (past)
• Mahfouz M. Michael,M.D.,Inc.

  • Internal Medicine Physician
  • San Fernando, CA
  • NPI 1609095587
  NPD (past)

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

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660780800000",
    "number": "1881746196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "TOPPENISH",
            "state": "WA",
            "postal_code": "989480190",
            "telephone_number": "509-865-2395",
            "fax_number": "509-865-0757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3896 BEVERLY AVE NE STE 40",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973051374",
            "telephone_number": "503-588-0076",
            "fax_number": "503-588-7578"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1437 S Atlantic Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900225015",
            "country_code": "US",
            "telephone_number": "323-268-6887",
            "fax_number": "323-268-9985",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUILLEN",
        "first_name": "ROBERTO",
        "middle_name": "CARLOS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-17",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "15859",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA207674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rguillen37810@yvfwc.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "YVFWC Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "3896 Beverly Ave NE Ste 40",
            "city": "Salem",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973051374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Guillermo Guevara Garcia
• Lori L Guidicattievans, CADC 1
• Rosemary Guild
• Nicholas Guillen Couple
• Renee Guillen, DDS
• Chance Gullon
• Kristan Gulseth
• Brian Gumbs, MD
• Joy Audrey Gummow, FNP-C
• Czarina L Gupton, PTA

• Physician Assistant in Salem, OR
• Providers in Salem, OR by specialty
• Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; 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.