=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003787201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUIDEWELL SANITAS I, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2025
-----------------------------------------------------
Last Update Date | 09/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12879 CITRUS PLAZA DR
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33625-3010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-522-5634
-----------------------------------------------------
Fax | 877-899-3913
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12879 CITRUS PLAZA DR
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33625-3010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-522-5634
-----------------------------------------------------
Fax | 877-899-3913
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MAYRA G TORRES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-918-2370
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------