MEDICARE: GUADALUPE MEDICAL CENTER INC

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861504342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUADALUPE MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	4469 S CONGRESS AVE STE 106
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4726
Country	:	US
Telephone Number	:	561-642-0768
Fax Number	:	561-642-0769

Provider Business Practice Location Address
First Line	:	4469 S CONGRESS AVE STE 106
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4726
Country	:	US
Telephone Number	:	561-642-0768
Fax Number	:	561-642-0769

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. OLGA VIRGINIA ROSAZZA
Credential	:
Telephone Number	:	561-642-0768

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	10/05/2012

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Directions to “GUADALUPE MEDICAL CENTER INC ” Practice Location

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