Provider Demographics
NPI:1629563960
Name:GUADALUPE SERVICIOS INTEGRALES
Entity Type:Organization
Organization Name:GUADALUPE SERVICIOS INTEGRALES
Other - Org Name:CLINICA VIRGEN DE GUADALUPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NITHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-903-7445
Mailing Address - Street 1:PO BOX 39662
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-9662
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:URB. SANTA URSULA O-4
Practice Address - Street 2:
Practice Address - City:CUSCO
Practice Address - State:CUSCO
Practice Address - Zip Code:99999
Practice Address - Country:PE
Practice Address - Phone:954-903-7445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical