=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952231227
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BG DORAL CARE NURSE REGISTRY CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2026
-----------------------------------------------------
Last Update Date | 05/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4005 NW 114TH AVE UNIT 22A
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33178-4373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-542-5770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4005 NW 114TH AVE UNIT 22A
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33178-4373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-542-5770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ERNESTO GUEVARA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-366-2050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------