Basic Information
| Provider Information | |||||||||
| NPI: | 1578291779 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GUIDEWELL SANITAS I, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8400 NW 33RD ST STE 100 | ||||||||
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| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331221937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446654827 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4980 E. IRLO BRONSON MEMORIAL HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | ST. CLOUD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8446654827 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2022 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | ESTRADA | ||||||||
| AuthorizedOfficialFirstName: | JUAN | ||||||||
| AuthorizedOfficialMiddleName: | DIEGO | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3059217619 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.