Healthcare Provider Details

I. General information

NPI: 1073289922
Provider Name (Legal Business Name): GOLD STAR MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 AVE LUIS MUNOZ MARIN
HORMIGUEROS PR
00660-1750
US

IV. Provider business mailing address

#184 CALLE VALENCIA URB. LA SALAMANCA
SAN GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-673-1238
  • Fax:
Mailing address:
  • Phone: 787-673-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SHAHID M CHAUDHARY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 787-673-1238