| Guadalupe Medical Center Inc | |
|
4469 S Congress Ave Ste 106 Lake Worth FL 33461-4726 | |
| (561) 642-0768 | |
| (561) 642-0769 |
| Full Name | Guadalupe Medical Center Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 4469 S Congress Ave Ste 106, Lake Worth, Florida |
| Authorized Official Name and Position | Olga Virginia Rosazza (OFFICE MANAGER) |
| Authorized Official Contact | 5616420768 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Guadalupe Medical Center Inc 4469 S Congress Ave Ste 106 Lake Worth FL 33461-4726 Ph: (561) 642-0768 | Guadalupe Medical Center Inc 4469 S Congress Ave Ste 106 Lake Worth FL 33461-4726 Ph: (561) 642-0768 |
| NPI Number | 1861504342 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 10/05/2012 |
| Medicare PECOS PAC ID | 1153396775 |
|---|---|
| Medicare Enrollment ID | O20040827000701 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861504342 | NPI | - | NPPES |
| 269435200 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Emilio E Castaneda |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1194858746 PECOS PAC ID: 2365421930 Enrollment ID: I20040716000667 |
| Provider Name | Carlos Coloma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124442314 PECOS PAC ID: 0244540011 Enrollment ID: I20151106000280 |
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