Healthcare Provider Details

I. General information

NPI: 1154059384
Provider Name (Legal Business Name): GUIDEWELL SANITAS I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 E. IRLO BRONSON MEMORIAL HIGHWAY
ST. CLOUD FL
34771
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 Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAYRA G TORRES
Title or Position: CFO
Credential:
Phone: 786-648-6285