Guillermo Guillen Bastidas, SURGICAL ASSISTANT

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

238.000761 Issued in IL

Practice address

19015 S Jodi Rd Ste H
Mokena, IL 60448-8534

Phone

(866) 787-4452

NPI assigned

Oct 31, 2022

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

State licenses

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

{
    "created_epoch": "1667174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1912614819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1926 W WINONA ST APT GRD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402676",
            "telephone_number": "980-441-9013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19015 S JODI RD STE H",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488534",
            "telephone_number": "866-787-4452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILLEN BASTIDAS",
        "first_name": "GUILLERMO",
        "credential": "SURGICAL ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-31",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "IL",
            "license": "238.000761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claudia Elena Gricus, MHS/CCC-SLP
• Alexandria Hope Griffin
• Tammy S Grode, M.A.,LCPC
• Melanie Grzesik-Duffy, MA, LCPC
• Jack G Guenther, OD
• Hiba Hammadi
• Shannon Michelle Hamning, BCBA
• Hanaa Hamoud, CNA
• Stephanie Hampton, C.O.T.A.
• Happy Sprouts Pediatric Health and Wellness LLC

• Surgical Assistant in Mokena, IL
• Providers in Mokena, IL by specialty
• Surgical Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.