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General NPI Number Information
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NPI Number | 1740691922
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Entity Type | Individual
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Provider Name | MR. ISRAEL GUAJARDO
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Gender | Male
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Dates
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Enumeration Date | 05/09/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 4097 E 104TH ST
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City | GRANT
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State | MI
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Zip | 49327-8696
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Country | US
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Telephone | 231-224-3377
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Fax | 231-834-5031
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Provider Business Mailing Address
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Address Line | 4097 E 104TH ST
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City | GRANT
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State | MI
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Zip | 49327-8696
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Country | US
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Telephone | 231-224-3377
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Fax | 231-834-5031
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | MI
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