Provider Demographics
NPI:1114575719
Name:GUIDEWELL SANITAS I, LLC
Entity Type:Organization
Organization Name:GUIDEWELL SANITAS I, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:DIEGO
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-882-2869
Mailing Address - Street 1:8400 NW 33RD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1937
Mailing Address - Country:US
Mailing Address - Phone:786-882-2869
Mailing Address - Fax:
Practice Address - Street 1:600 NE 22ND TER STE 302-306
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4707
Practice Address - Country:US
Practice Address - Phone:844-665-4827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GUIDEWELL SANITAS I, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-28
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty