Provider Demographics
NPI:1083886873
Name:GUADALUPE MEDICAL INNOVATIONS CORPORATION
Entity Type:Organization
Organization Name:GUADALUPE MEDICAL INNOVATIONS CORPORATION
Other - Org Name:GMI HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:BBA
Authorized Official - Phone:210-788-3241
Mailing Address - Street 1:3503 LURA LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-2366
Mailing Address - Country:US
Mailing Address - Phone:210-736-4399
Mailing Address - Fax:
Practice Address - Street 1:113 PARAMOUNT AVE # B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-6179
Practice Address - Country:US
Practice Address - Phone:210-736-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747360Medicare UPIN