Provider Demographics
NPI:1447991609
Name:CLINICA GUADALUPANA
Entity type:Organization
Organization Name:CLINICA GUADALUPANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:888-449-7799
Mailing Address - Street 1:CLINICA GUADALUPANA
Mailing Address - Street 2:500 WESTOVER DR #19593
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:C. OSCAR WILDE 112 VILLA RUIZ
Practice Address - Street 2:
Practice Address - City:PUREPERO DE ECHAIZ
Practice Address - State:MICH
Practice Address - Zip Code:58760
Practice Address - Country:MX
Practice Address - Phone:888-449-7799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-04
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
UBO670218258OtherSTATE