Provider Demographics
NPI:1093180622
Name:GUADAMUZ, ANTHONY JOSE (AP, MACOM)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOSE
Last Name:GUADAMUZ
Suffix:
Gender:M
Credentials:AP, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S DIXIE HWY
Mailing Address - Street 2:STE 211
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2273
Mailing Address - Country:US
Mailing Address - Phone:786-502-2173
Mailing Address - Fax:
Practice Address - Street 1:430 S DIXIE HWY
Practice Address - Street 2:STE 211
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2273
Practice Address - Country:US
Practice Address - Phone:786-502-2173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3673171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist