Healthcare Provider Details

I. General information

NPI: 1346208485
Provider Name (Legal Business Name): GOLDEN MEDICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6365 TAFT ST
HOLLYWOOD FL
33024-5952
US

IV. Provider business mailing address

6365 TAFT ST
HOLLYWOOD FL
33024-5952
US

V. Phone/Fax

Practice location:
  • Phone: 954-967-6061
  • Fax: 954-967-6062
Mailing address:
  • Phone: 954-967-6061
  • Fax: 954-967-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LUIS MANUEL LAZO
Title or Position: PRESIDENT
Credential:
Phone: 954-967-6061