MEDICARE: GUIDEWELL SANITAS I, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1265811384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDEWELL SANITAS I, LLC

Provider Business Mailing Address
First Line	:	8400 NW 33RD ST STE 201
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33122-1937
Country	:	US
Telephone Number	:	786-882-2869
Fax Number	:	305-921-7355

Provider Business Practice Location Address
First Line	:	18610 NW 87TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-3518
Country	:	US
Telephone Number	:	305-921-7621
Fax Number	:	305-921-7355

Authorized Official
Title or Position	:	CEO
Name	:	JUAN DIEGO ESTRADA
Credential	:	MD
Telephone Number	:	786-882-2869

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	02/06/2024

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1215328224 — GUIDEWELL SANITAS I, LLC
Practice Location Address:

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Practice Fax: 305-921-7355

Directions to “GUIDEWELL SANITAS I, LLC ” Practice Location

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