Healthcare Provider Details

I. General information

NPI: 1811510282
Provider Name (Legal Business Name): LARA NICOLE GOLDSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date: 01/18/2022
Reactivation Date: 02/10/2022

III. Provider practice location address

20900 BISCAYNE BOULEVARD
AVENTURA FL
33180
US

IV. Provider business mailing address

20900 BISCAYNE BOULEVARD
AVENTURA FL
33180
US

V. Phone/Fax

Practice location:
  • Phone: 305-682-2483
  • Fax: 305-682-5250
Mailing address:
  • Phone: 305-682-2483
  • Fax: 305-682-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME160989
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60258
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: