Provider Demographics
NPI:1184839128
Name:GUARDIAN HEALTH CENTER, PA
Entity Type:Organization
Organization Name:GUARDIAN HEALTH CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-438-0258
Mailing Address - Street 1:3550 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 710
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3841
Mailing Address - Country:US
Mailing Address - Phone:305-438-0258
Mailing Address - Fax:305-438-0261
Practice Address - Street 1:3550 BISCAYNE BLVD
Practice Address - Street 2:SUITE 710
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3841
Practice Address - Country:US
Practice Address - Phone:305-438-0258
Practice Address - Fax:305-438-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262354400Medicaid
FLK3081Medicare PIN