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General NPI Number Information
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NPI Number | 1629547104
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Entity Type | Organization
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Legal Business Name | GUADALUPE MEDICAL GROUP LLC
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 1855 E GUADALUPE RD STE 112
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City | TEMPE
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State | AZ
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Zip | 85283-3269
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Country | US
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Telephone | 480-839-8552
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Fax | 480-926-2260
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Provider Business Mailing Address
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Address Line | 4432 N MILLER RD STE 102
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-3697
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Country | US
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Telephone | 480-306-7227
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Fax | 480-306-7238
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL CORMIER
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Credential |
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Telephone | 480-926-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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