Provider Demographics
NPI:1861662900
Name:GRACE G GUADIZ MD PA
Entity type:Organization
Organization Name:GRACE G GUADIZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:GONZALES
Authorized Official - Last Name:GUADIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-675-2148
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33975-0625
Mailing Address - Country:US
Mailing Address - Phone:863-675-2148
Mailing Address - Fax:863-675-7078
Practice Address - Street 1:920 W COWBOY WAY
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935
Practice Address - Country:US
Practice Address - Phone:863-675-2148
Practice Address - Fax:863-675-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29639207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD86338Medicare UPIN