Healthcare Provider Details

I. General information

NPI: 1396214094
Provider Name (Legal Business Name): GUIDEWELL SANITAS I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9580 W COLONIAL DR
OCOEE FL
34761-6947
US

IV. Provider business mailing address

8400 NW 33RD ST STE 201
DORAL FL
33122-1937
US

V. Phone/Fax

Practice location:
  • Phone: 844-665-4827
  • Fax:
Mailing address:
  • Phone: 786-882-2869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUAN DIEGO ESTRADA
Title or Position: PRESIDENT
Credential: MD
Phone: 786-882-2869