Provider Demographics
NPI:1053169375
Name:GUIRADO, EDGAR JESUS
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:JESUS
Last Name:GUIRADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5085 NW 7TH ST APT 411
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3453
Mailing Address - Country:US
Mailing Address - Phone:305-833-9411
Mailing Address - Fax:
Practice Address - Street 1:9555 SW 175TH TER # 555
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5604
Practice Address - Country:US
Practice Address - Phone:786-281-4193
Practice Address - Fax:130-564-8334
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-332054106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician