Healthcare Provider Details

I. General information

NPI: 1083214142
Provider Name (Legal Business Name): GOJI GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14394 COMMERCE WAY
MIAMI LAKES FL
33016-1501
US

IV. Provider business mailing address

14394 COMMERCE WAY
MIAMI LAKES FL
33016-1501
US

V. Phone/Fax

Practice location:
  • Phone: 786-755-7428
  • Fax: 786-755-7426
Mailing address:
  • Phone: 786-755-7428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ANTONIO OTAYEK
Title or Position: CFO
Credential:
Phone: 786-440-9002