Healthcare Provider Details

I. General information

NPI: 1528654860
Provider Name (Legal Business Name): LA EDAD DORADA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2020
Last Update Date: 12/20/2020
Certification Date: 12/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 NW 119TH ST
NORTH MIAMI FL
33168-6240
US

IV. Provider business mailing address

1071 NW 119TH ST
NORTH MIAMI FL
33168-6240
US

V. Phone/Fax

Practice location:
  • Phone: 786-803-8271
  • Fax: 786-803-8291
Mailing address:
  • Phone: 786-803-8271
  • Fax: 786-803-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE CLAVERO
Title or Position: PRESIDENT
Credential:
Phone: 786-553-2717