Provider Demographics
NPI:1447134119
Name:GUADALUPE, ANNA MARIA
Entity type:Individual
Prefix:
First Name:ANNA MARIA
Middle Name:
Last Name:GUADALUPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36590 W MEDITERRANEAN WAY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-4750
Mailing Address - Country:US
Mailing Address - Phone:602-930-8955
Mailing Address - Fax:
Practice Address - Street 1:36590 W MEDITERRANEAN WAY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-4750
Practice Address - Country:US
Practice Address - Phone:602-930-8955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL13389H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility