Provider Demographics
NPI:1306067293
Name:GUAJIRO MEDICAL CENTER INC
Entity type:Organization
Organization Name:GUAJIRO MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:FIALLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-836-8059
Mailing Address - Street 1:555 E 25TH ST STE 118-119
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3848
Mailing Address - Country:US
Mailing Address - Phone:305-836-8060
Mailing Address - Fax:
Practice Address - Street 1:555 E 25TH ST STE 118-119
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3848
Practice Address - Country:US
Practice Address - Phone:305-836-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208D00000X208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty