Provider Demographics
NPI:1750583803
Name:GUARDIOLA AMADO, VICTOR DANIEL (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:DANIEL
Last Name:GUARDIOLA AMADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VICTOR
Other - Middle Name:DANIEL
Other - Last Name:GUARDIOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9350 SUNSET DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3286
Mailing Address - Country:US
Mailing Address - Phone:786-594-4210
Mailing Address - Fax:
Practice Address - Street 1:8900 N KENDALL DR
Practice Address - Street 2:MIAMI CANCER INSTITUTE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2118
Practice Address - Country:US
Practice Address - Phone:786-596-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 117334207RH0003X
FLME104043207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010425800Medicaid
FLHR254YMedicare PIN
KY7100113350Medicaid