Healthcare Provider Details

I. General information

NPI: 1497340319
Provider Name (Legal Business Name): GOLDEN MEDICAL DIAGNOSTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4995 NW 72ND AVE STE 401
MIAMI FL
33166-5643
US

IV. Provider business mailing address

4995 NW 72ND AVE STE 401
MIAMI FL
33166-5643
US

V. Phone/Fax

Practice location:
  • Phone: 786-558-5860
  • Fax:
Mailing address:
  • Phone: 786-558-5860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SERGIO RAMOS
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 786-973-6388