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General NPI Number Information
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NPI Number | 1861662900
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Entity Type | Organization
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Legal Business Name | GRACE G GUADIZ MD PA
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 920 W COWBOY WAY
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City | LABELLE
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State | FL
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Zip | 33935
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Country | US
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Telephone | 863-675-2148
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Fax | 863-675-7078
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Provider Business Mailing Address
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Address Line | PO BOX 625
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City | LABELLE
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State | FL
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Zip | 33975-0625
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Country | US
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Telephone | 863-675-2148
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Fax | 863-675-7078
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GRACE GONZALES GUADIZ
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Credential | M.D.
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Telephone | 863-675-2148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | ME29639
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License Number State | FL
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