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General NPI Number Information
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NPI Number | 1700376993
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Entity Type | Organization
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Legal Business Name | CLINICA GUADALUPE, CORP.
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 5475 GOLDEN GATE PKWY STE 5W
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City | NAPLES
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State | FL
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Zip | 34116-7529
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Country | US
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Telephone | 239-315-4821
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Fax | 239-315-4824
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Provider Business Mailing Address
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Address Line | 19050 SW 194TH AVE
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City | MIAMI
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State | FL
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Zip | 33187-1945
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Country | US
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Telephone | 786-344-8916
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BELKIS A ALVAREZ
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Credential |
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Telephone | 786-344-8916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | HCC12895
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License Number State |
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