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General NPI Number Information
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NPI Number | 1619428877
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Entity Type | Organization
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Legal Business Name | PROF/GUIDEWELL SANITAS MED CNT
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 11211 VERANDA CT
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City | BRADENTON
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State | FL
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Zip | 34209-7101
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Country | US
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Telephone | 516-353-5770
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Fax |
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Provider Business Mailing Address
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Address Line | 11211 VERANDA CT
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City | BRADENTON
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State | FL
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Zip | 34209-7101
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Country | US
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Telephone | 516-353-5770
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Fax |
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Authorized Official
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Title or Position | PHYSIAN
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Name | DR. HUGO HERNAN VELARDE-LASSO
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Credential | M.D
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Telephone | 516-353-5770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 226893
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | ME125796
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME125796
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License Number State | FL
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