Provider Demographics
NPI:1700376993
Name:CLINICA GUADALUPE, CORP.
Entity Type:Organization
Organization Name:CLINICA GUADALUPE, CORP.
Other - Org Name:CLINICA GUADALUPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELKIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-344-8916
Mailing Address - Street 1:19050 SW 194TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-1945
Mailing Address - Country:US
Mailing Address - Phone:786-344-8916
Mailing Address - Fax:
Practice Address - Street 1:5475 GOLDEN GATE PKWY STE 5W
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7529
Practice Address - Country:US
Practice Address - Phone:239-315-4821
Practice Address - Fax:239-315-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HCC12895261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1PENDINGMedicaid