Healthcare Provider Details

I. General information

NPI: 1447991609
Provider Name (Legal Business Name): CLINICA GUADALUPANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2022
Last Update Date: 04/04/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C. OSCAR WILDE 112 VILLA RUIZ
PUREPERO DE ECHAIZ MICH
58760
MX

IV. Provider business mailing address

CLINICA GUADALUPANA 500 WESTOVER DR #19593
SANFORD NC
27330
US

V. Phone/Fax

Practice location:
  • Phone: 888-449-7799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: ALFONSO VEGA
Title or Position: OWNER
Credential: DR
Phone: 888-449-7799