Provider Demographics
NPI:1619022100
Name:GUARDIAN ANGEL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:GUARDIAN ANGEL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER.
Authorized Official - Prefix:
Authorized Official - First Name:ALEXEIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MACUYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-877-5320
Mailing Address - Street 1:3550 W WATERS AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2767
Mailing Address - Country:US
Mailing Address - Phone:813-877-5320
Mailing Address - Fax:813-644-6919
Practice Address - Street 1:3550 W WATERS AVE STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2767
Practice Address - Country:US
Practice Address - Phone:813-877-5320
Practice Address - Fax:813-644-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26QR0401X261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL686804Medicare ID - Type UnspecifiedORF