Provider Demographics
NPI:1811448004
Name:GUIDERA, MATTHEW H (LAC, DIPLOM)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:H
Last Name:GUIDERA
Suffix:
Gender:M
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 BAY CLUB DR APT 4
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1805
Mailing Address - Country:US
Mailing Address - Phone:857-928-0824
Mailing Address - Fax:
Practice Address - Street 1:1555 BONAVENTURE BLVD STE 1004
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-4041
Practice Address - Country:US
Practice Address - Phone:954-678-8457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-22
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3771171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist