Provider Demographics
NPI:1467963116
Name:GUILARTE PAZOS, JOSE ANDRO SR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:ANDRO
Last Name:GUILARTE PAZOS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 RANKIN ST
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5753
Mailing Address - Country:US
Mailing Address - Phone:941-264-9307
Mailing Address - Fax:
Practice Address - Street 1:1931 RANKIN ST
Practice Address - Street 2:
Practice Address - City:KINDRED
Practice Address - State:FL
Practice Address - Zip Code:34744-5753
Practice Address - Country:US
Practice Address - Phone:941-264-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-21
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-24-72368103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst