Provider Demographics
NPI:1972399475
Name:GUADALUPE, JAMILES
Entity type:Individual
Prefix:
First Name:JAMILES
Middle Name:
Last Name:GUADALUPE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5614 PINNACLE HEIGHTS CIR APT 303
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-4017
Mailing Address - Country:US
Mailing Address - Phone:929-586-9338
Mailing Address - Fax:
Practice Address - Street 1:5614 PINNACLE HEIGHTS CIR APT 303
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-4017
Practice Address - Country:US
Practice Address - Phone:929-586-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-19
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty