Healthcare Provider Details

I. General information

NPI: 1760625354
Provider Name (Legal Business Name): THE GOLDEN AGE MEDICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NW 79TH AVE SUITE 531
DORAL FL
33166-6556
US

IV. Provider business mailing address

3900 NW 79TH AVE SUITE 531
DORAL FL
33166-6556
US

V. Phone/Fax

Practice location:
  • Phone: 305-351-6996
  • Fax: 305-675-2668
Mailing address:
  • Phone: 305-351-6996
  • Fax: 305-675-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER VALIENTE
Title or Position: PRESIDENT
Credential:
Phone: 305-351-6996