Healthcare Provider Details

I. General information

NPI: 1285733212
Provider Name (Legal Business Name): PAUL L GUADAGNO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6075 SUNSET DR 203
SOUTH MIAMI FL
33143-5000
US

IV. Provider business mailing address

7801 SW 133RD CT
MIAMI FL
33183-3319
US

V. Phone/Fax

Practice location:
  • Phone: 305-971-0302
  • Fax: 305-971-8222
Mailing address:
  • Phone: 786-701-8671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH9004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: